Provider Demographics
NPI:1558054197
Name:DEERY, REAGAN J (SLP)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:J
Last Name:DEERY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:J
Other - Last Name:NETERER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:228 S CHURCH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2608
Mailing Address - Country:US
Mailing Address - Phone:412-628-8882
Mailing Address - Fax:
Practice Address - Street 1:1045 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7201
Practice Address - Country:US
Practice Address - Phone:301-739-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL017003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist