Provider Demographics
NPI:1265884688
Name:KANE, REAGAN (SLP)
Entity type:Individual
Prefix:
First Name:REAGAN
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 OXNARD ST
Mailing Address - Street 2:#3
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4987
Mailing Address - Country:US
Mailing Address - Phone:818-422-3931
Mailing Address - Fax:
Practice Address - Street 1:11035 OXNARD ST
Practice Address - Street 2:#3
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4987
Practice Address - Country:US
Practice Address - Phone:818-422-3931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2016-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist