Provider Demographics
NPI:1154762011
Name:JIREGNA, MAHALET CANDACE (AUD)
Entity type:Individual
Prefix:
First Name:MAHALET
Middle Name:CANDACE
Last Name:JIREGNA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:3144 EL CAMINO REAL STE 105
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2194
Practice Address - Country:US
Practice Address - Phone:760-729-7800
Practice Address - Fax:760-729-7878
Is Sole Proprietor?:No
Enumeration Date:2013-07-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA9464231H00000X
CA10156237700000X
CAAU3551231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist