Active NPI
Regina Marie Nolan, M.S. CCC-SLP
- Speech-Language Pathologist
- Ballwin, MO
National Provider Identifier
1083837215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 109811
- Practice address
- 1208 Foxview Ter
Ballwin, MO 63011-4316 - Phone
- (314) 719-7140
- NPI assigned
- Apr 10, 2007
- Last updated
- Jun 4, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | 109811 | MO | |
| Speech-Language Pathologist | 235Z00000X | 109811 | MO | Primary |
Addresses
Primary practice location
1208 Foxview Ter
Ballwin, MO 63011-4316
Mailing address
1208 Foxview Ter
Ballwin, MO 63011-4316
Phone (314) 719-7140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 109811 | MO | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433376000000",
"number": "1083837215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1208 FOXVIEW TER",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630114316",
"telephone_number": "314-719-7140"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 FOXVIEW TER",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630114316",
"telephone_number": "314-719-7140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOLAN",
"first_name": "REGINA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "M.S. CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2015-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "MO",
"license": "109811",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "MO",
"license": "109811",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ballwin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.