Provider Demographics
NPI:1831323633
Name:CHURCH-HAYES, REGINA MARIE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:CHURCH-HAYES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43553 JACKSON HOLE CIR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3960
Mailing Address - Country:US
Mailing Address - Phone:703-737-3131
Mailing Address - Fax:703-669-4082
Practice Address - Street 1:43553 JACKSON HOLE CIR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3960
Practice Address - Country:US
Practice Address - Phone:703-737-3131
Practice Address - Fax:703-669-4082
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003952235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist