Provider Demographics
NPI:1780774703
Name:WENDEL, REGINA A (AUD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:A
Last Name:WENDEL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7227 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4853
Mailing Address - Country:US
Mailing Address - Phone:330-629-2144
Mailing Address - Fax:330-629-2140
Practice Address - Street 1:7227 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4853
Practice Address - Country:US
Practice Address - Phone:330-629-2144
Practice Address - Fax:330-629-2140
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA-1008231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000243982OtherANTHEM PIN
OH2591575Medicaid
OH000000243982OtherANTHEM PIN