Provider Demographics
NPI:1568899011
Name:REGESTER, COURTNEY WYNN (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:WYNN
Last Name:REGESTER
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:JANEAN
Other - Last Name:WYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CF-SLP
Mailing Address - Street 1:8337 COUNTS MASSIE RD
Mailing Address - Street 2:102
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72113-5376
Mailing Address - Country:US
Mailing Address - Phone:501-617-3086
Mailing Address - Fax:
Practice Address - Street 1:8337 COUNTS MASSIE RD
Practice Address - Street 2:102
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72113-5376
Practice Address - Country:US
Practice Address - Phone:501-617-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8730235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR199653721Medicaid