Provider Demographics
NPI:1043463755
Name:GREGORY, MARY TODD (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:TODD
Last Name:GREGORY
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-0220
Mailing Address - Country:US
Mailing Address - Phone:606-256-4449
Mailing Address - Fax:
Practice Address - Street 1:240 E MAIN ST
Practice Address - Street 2:GREGORY BUILDING
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2210
Practice Address - Country:US
Practice Address - Phone:606-256-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0008235Z00000X
FLSA 8631235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist