Provider Demographics
NPI:1689062457
Name:SMITH, REGINA (HAS)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HAS
Mailing Address - Street 1:8800 SE SUNNYSIDE RD STE 300N
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5703
Mailing Address - Country:US
Mailing Address - Phone:281-286-2999
Mailing Address - Fax:512-607-4893
Practice Address - Street 1:8911 PATTERSON AVE STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-6370
Practice Address - Country:US
Practice Address - Phone:804-282-0055
Practice Address - Fax:804-282-4762
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA237600000X
VA2102002752237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter