Provider Demographics
NPI:1558795104
Name:WINGETT, GREGORY LEE
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:WINGETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 LOCKHAVEN DR NE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-3768
Mailing Address - Country:US
Mailing Address - Phone:971-218-7382
Mailing Address - Fax:
Practice Address - Street 1:784 LOCKHAVEN DR NE
Practice Address - Street 2:BUILDING C
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-3768
Practice Address - Country:US
Practice Address - Phone:971-218-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor