Doctor Name: | REGAN MARIE WAHLBERG |
NPI Number: | 1104035906 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. CCC-SLP |
License Number: | SLP4879 |
Business Practice Address: | 1817 N 7th St Phoenix, AZ - 850062133 |
Business Phone Number: | 6025385123 |
Business Fax Number: | |
Mailing Address: | 2628 E Anderson Dr, PHOENIX |
State: | AZ |
Postal Code: | 850322404 |
Phone Number: | 6025385123 |
Fax Number: | |
NPI Enumeration Date: | 05/21/2007 |
NPI Last Update Date: | 08/18/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP4879 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |