Provider Demographics
NPI:1396994570
Name:PASSMORE, REGINA (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6180
Mailing Address - Country:US
Mailing Address - Phone:870-269-3443
Mailing Address - Fax:
Practice Address - Street 1:210 HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6180
Practice Address - Country:US
Practice Address - Phone:870-269-3443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116974743Medicaid