Healthcare Provider Details

I. General information

NPI: 1760909022
Provider Name (Legal Business Name): ASHLEE REGAN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 TERMINO AVE
LONG BEACH CA
90804-4123
US

IV. Provider business mailing address

8633 ECLIPSE ST
EL PASO TX
79904-2641
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-6791
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number112162
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: