Provider Demographics
NPI:1073774592
Name:GREGORY, LINDA FAIRCHILD (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:FAIRCHILD
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 501
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-0501
Mailing Address - Country:US
Mailing Address - Phone:859-200-1289
Mailing Address - Fax:877-572-3565
Practice Address - Street 1:2150 LEXINGTON RD
Practice Address - Street 2:SUITE G
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7924
Practice Address - Country:US
Practice Address - Phone:859-333-8147
Practice Address - Fax:877-572-3565
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0835235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist