Provider Demographics
NPI:1730286295
Name:ANDERSON-SPANN, REGINA ROBIN
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:ROBIN
Last Name:ANDERSON-SPANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 W. NATIONAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295
Mailing Address - Country:US
Mailing Address - Phone:414-531-7165
Mailing Address - Fax:414-342-2207
Practice Address - Street 1:5000 W. NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295
Practice Address - Country:US
Practice Address - Phone:414-531-7165
Practice Address - Fax:414-342-2207
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCSW0000006513104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker