Provider Demographics
NPI:1134829898
Name:REGIDOR, IVY MARIE SILVESTRE
Entity type:Individual
Prefix:
First Name:IVY MARIE
Middle Name:SILVESTRE
Last Name:REGIDOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8761 BITTERCRESS DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80925-9653
Mailing Address - Country:US
Mailing Address - Phone:719-439-6682
Mailing Address - Fax:
Practice Address - Street 1:3055 AUSTIN BLUFFS PKWY STE C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5758
Practice Address - Country:US
Practice Address - Phone:719-344-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health