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NPI Code Detail

MEDICARE: REGINA DWYER URBAN CCC SLP

MEDICARE: REGINA DWYER URBAN CCC 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
1235Z00000XSpeech-Language Pathologist2202000712VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1195246OTHERVABCBS
23822946OTHERVACIGNA PPO
311123OTHERVACARENET
4230391OTHERVAALLIANCE NETWORK
5259332OTHERVASOUTHERN HEALTH
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558478552
Entity Type Code : Individual
Provider Name (Legal Business Name) : REGINA DWYER URBAN CCC SLP
Provider Business Mailing Address
First Line : 4202 HERMITAGE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23227-3755
Country : US
Telephone Number : 804-266-6699
Fax Number : 804-264-5988
Provider Business Practice Location Address
First Line : 4202 HERMITAGE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23227-3755
Country : US
Telephone Number : 804-266-6699
Fax Number : 804-264-5988
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2006
Last Update Date : 07/08/2007

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