MEDICARE: MRS. COURTNEY WYNN REGESTER M.S., CF-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	P8730	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568899011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY WYNN REGESTER M.S., CF-SLP

Provider Business Mailing Address
First Line	:	8337 COUNTS MASSIE RD
Second Line	:	102
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-5376
Country	:	US
Telephone Number	:	501-617-3086
Fax Number	:

Provider Business Practice Location Address
First Line	:	8337 COUNTS MASSIE RD
Second Line	:	102
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72113-5376
Country	:	US
Telephone Number	:	501-617-3086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2013
Last Update Date	:	06/17/2014

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Directions to “ MRS. COURTNEY WYNN REGESTER M.S., CF-SLP” Practice Location

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