Provider Demographics
NPI:1043012578
Name:CONKLIN, REAGEN CORIDON
Entity type:Individual
Prefix:
First Name:REAGEN
Middle Name:CORIDON
Last Name:CONKLIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 CJ HECK RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IL
Mailing Address - Zip Code:62881-3727
Mailing Address - Country:US
Mailing Address - Phone:618-780-4160
Mailing Address - Fax:
Practice Address - Street 1:1827 E MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-6589
Practice Address - Country:US
Practice Address - Phone:618-608-0122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist