| NPI | 1093021230 |
|---|---|
| Former Name | REGINA MARIE ILLIG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: PA SL008947) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: AK 100749) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2021-05-06 |