| Doctor Name: | REGINALD JACK WIDICK |
| NPI Number: | 1033384128 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 615 |
| Business Practice Address: | 1043 Pedigo Way Suite 40 Bowling Green, KY - 421037196 |
| Business Phone Number: | 2707457182 |
| Business Fax Number: | |
| Mailing Address: | 330 Franklin Rd, Suite 135a-121 BRENTWOOD |
| State: | TN |
| Postal Code: | 370273280 |
| Phone Number: | 2707457182 |
| Fax Number: | |
| NPI Enumeration Date: | 04/29/2008 |
| NPI Last Update Date: | 08/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 237700000X |
| License Number: | 615 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TN |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Hearing Instrument Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Individuals who test hearing for the selection, adaptation, fitting, adjusting, servicing, and sale of hearing aids. Hearing Instrument Specialist is a designation provided individuals who qualify by the National Hearing Aid Society |