Provider Demographics
NPI:1952524530
Name:MCCONVILLE, REGINA MICHELLE (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MICHELLE
Last Name:MCCONVILLE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:MICHELLE
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1724 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47620-8226
Mailing Address - Country:US
Mailing Address - Phone:812-838-6880
Mailing Address - Fax:
Practice Address - Street 1:150 N ROSENBERGER AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6503
Practice Address - Country:US
Practice Address - Phone:812-476-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002357A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist