Provider Demographics
NPI:1336484476
Name:GREGORY, JOANN C (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:C
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9620 MIDDLE WARREN RD
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-9245
Mailing Address - Country:US
Mailing Address - Phone:870-879-2208
Mailing Address - Fax:
Practice Address - Street 1:9620 MIDDLE WARREN RD
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-9245
Practice Address - Country:US
Practice Address - Phone:870-879-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist