Provider Demographics
NPI:1033479944
Name:GREGG, KRISTA D (CCC- SLP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:D
Last Name:GREGG
Suffix:
Gender:F
Credentials:CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7359 DIBBLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-5124
Mailing Address - Country:US
Mailing Address - Phone:206-930-6959
Mailing Address - Fax:
Practice Address - Street 1:7359 DIBBLE AVE NORTHWEST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-6270
Practice Address - Country:US
Practice Address - Phone:206-930-6959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60276914235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist