Provider Demographics
NPI:1447768619
Name:GREGORY, KATELYN (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 SAGE HOLW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3150
Mailing Address - Country:US
Mailing Address - Phone:706-993-6331
Mailing Address - Fax:
Practice Address - Street 1:6301 GASTON AVE
Practice Address - Street 2:750
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214
Practice Address - Country:US
Practice Address - Phone:214-295-5374
Practice Address - Fax:214-245-5217
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX396952355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant