Doctor Name: | MRS. REGINA MARIE NOLAN |
NPI Number: | 1083837215 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | 109811 |
Business Practice Address: | 1208 Foxview Ter Ballwin, MO - 630114316 |
Business Phone Number: | 3147197140 |
Business Fax Number: | |
Mailing Address: | 1208 Foxview Ter, BALLWIN |
State: | MO |
Postal Code: | 630114316 |
Phone Number: | 3147197140 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 06/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320900000X |
License Number: | 109811 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MO |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |