Individual
REGINALD WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1961 MIDWAY ST, SHREVEPORT, LA 71108-2201
(318) 603-6300
Mailing address
1961 MIDWAY ST, SHREVEPORT, LA 71108-2201
(318) 603-6300
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3101
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235Z00000X
—
LA
Enumeration date
08/26/2021
Last updated
08/26/2021
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