Provider Demographics
NPI:1750520474
Name:REGAN, CORI ANN (MA CCC-SLP, BCBA)
Entity type:Individual
Prefix:MRS
First Name:CORI
Middle Name:ANN
Last Name:REGAN
Suffix:
Gender:F
Credentials:MA CCC-SLP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FINLAY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3513
Mailing Address - Country:US
Mailing Address - Phone:718-605-2715
Mailing Address - Fax:718-605-2715
Practice Address - Street 1:33 FINLAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3513
Practice Address - Country:US
Practice Address - Phone:718-605-2715
Practice Address - Fax:718-605-2715
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009857235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist