Provider Demographics
NPI:1619344280
Name:MAUZY, REGINA GUTIERREZ (MSCCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:GUTIERREZ
Last Name:MAUZY
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SEDGEBROOK CT APT 101
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7264
Mailing Address - Country:US
Mailing Address - Phone:434-509-9254
Mailing Address - Fax:
Practice Address - Street 1:200 LILLIAN LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4378
Practice Address - Country:US
Practice Address - Phone:434-385-6977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist