Provider Demographics
NPI:1619902244
Name:PRESLEY, REGINA M (AUD, CCC/A)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:M
Last Name:PRESLEY
Suffix:
Gender:F
Credentials:AUD, CCC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:STE 250
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:443-849-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD655231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS1290025OtherCAREFIRST REGIONAL GBMC
MDKJ47-68702902OtherCAREFIRST OF MD GBMC
MDP00287329Medicare PIN
MD676LJ950Medicare PIN