Provider Demographics
NPI:1013561125
Name:EVERISS WEAVER, REGAN (AUD)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:EVERISS WEAVER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REGAN
Other - Middle Name:
Other - Last Name:EVERISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5533 MAHONING AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-2366
Mailing Address - Country:US
Mailing Address - Phone:330-480-3533
Mailing Address - Fax:330-480-3535
Practice Address - Street 1:5533 MAHONING AVE FL 2
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2366
Practice Address - Country:US
Practice Address - Phone:330-480-3533
Practice Address - Fax:330-480-3535
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02205231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0363350Medicaid