Provider Demographics
NPI:1851722474
Name:MEYER, REGINA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:LYNN
Last Name:MEYER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 OGLESBY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4617
Mailing Address - Country:US
Mailing Address - Phone:312-620-3643
Mailing Address - Fax:309-452-7633
Practice Address - Street 1:706 OGLESBY AVE STE 105
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-620-3643
Practice Address - Fax:309-452-7633
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-07
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
IL071008753103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist