Provider Demographics
NPI:1992076772
Name:REGAN, MARILYN (SLP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:REGAN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PRIMROSE ST.
Mailing Address - Street 2:
Mailing Address - City:LINCOLNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10540
Mailing Address - Country:US
Mailing Address - Phone:914-277-3777
Mailing Address - Fax:
Practice Address - Street 1:250 ROUTE 202
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3205
Practice Address - Country:US
Practice Address - Phone:914-277-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019050-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist