Provider Demographics
NPI:1659596104
Name:MCINTYRE, REGINA A (SLP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-3217
Mailing Address - Country:US
Mailing Address - Phone:215-788-8164
Mailing Address - Fax:
Practice Address - Street 1:817 2ND AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-3217
Practice Address - Country:US
Practice Address - Phone:215-788-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007828235Z00000X
PASLOO7828251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Not Answered251E00000XAgenciesHome Health