Individual
RUTH REGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
29718 N VIRGINIA LN, WAUCONDA, IL 60084-9768
(847) 702-5102
Mailing address
29718 N VIRGINIA LN, WAUCONDA, IL 60084-9768
(847) 702-5102
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
R250-7658-3812
IL
Other
Enumeration date
11/03/2008
Last updated
11/03/2008
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