Provider Demographics
NPI:1487649893
Name:GREGG, ELLEN MEYER (PHD, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MEYER
Last Name:GREGG
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:1332 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2123
Mailing Address - Country:US
Mailing Address - Phone:970-356-6132
Mailing Address - Fax:
Practice Address - Street 1:UNC SPEECH AND AUDIOLOGY CLINIC
Practice Address - Street 2:GUNTER HALL ROOM 0330
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80639-0001
Practice Address - Country:US
Practice Address - Phone:970-351-2012
Practice Address - Fax:970-351-2974
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00542688235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07542681Medicaid
CO07542681Medicaid