Provider Demographics
NPI:1205671732
Name:HAGGLUND, REGINA BERNADETTE
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:BERNADETTE
Last Name:HAGGLUND
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 1:11235 DISTINCTIVE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-9458
Mailing Address - Country:US
Mailing Address - Phone:708-479-5555
Mailing Address - Fax:708-479-5055
Practice Address - Street 1:11235 DISTINCTIVE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-9458
Practice Address - Country:US
Practice Address - Phone:708-479-5555
Practice Address - Fax:708-479-5055
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029913363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health