Provider Demographics
NPI:1013967868
Name:SLEDGE, REGINA ANN (MA, CCC-A)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ANN
Last Name:SLEDGE
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11578 SW ROLLING HILLS RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010
Mailing Address - Country:US
Mailing Address - Phone:316-775-3428
Mailing Address - Fax:
Practice Address - Street 1:5500 E KELLOGG AVE
Practice Address - Street 2:ROBERT J DOLE VA MEDICAL CENTER
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1607
Practice Address - Country:US
Practice Address - Phone:316-634-3041
Practice Address - Fax:316-681-5591
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1980231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist