Provider Demographics
NPI:1558478552
Name:URBAN, REGINA DWYER (CCC SLP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:DWYER
Last Name:URBAN
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3755
Mailing Address - Country:US
Mailing Address - Phone:804-266-6699
Mailing Address - Fax:804-264-5988
Practice Address - Street 1:4202 HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3755
Practice Address - Country:US
Practice Address - Phone:804-266-6699
Practice Address - Fax:804-264-5988
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195246OtherBCBS
VA3822946OtherCIGNA PPO
VA11123OtherCARENET
VA230391OtherALLIANCE NETWORK
VA259332OtherSOUTHERN HEALTH
VA4978773Medicaid
VA4978773Medicaid