Provider Demographics
NPI:1447341367
Name:REGER, CHARLES ALBERT (MA)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALBERT
Last Name:REGER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PARK PLACE CIRCLE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:45645
Mailing Address - Country:US
Mailing Address - Phone:574-243-7766
Mailing Address - Fax:574-243-7796
Practice Address - Street 1:425 PARK PLACE CIRCLE
Practice Address - Street 2:SUITE 200
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:45645
Practice Address - Country:US
Practice Address - Phone:574-243-7766
Practice Address - Fax:574-243-7796
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23001942231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist