Provider Demographics
NPI:1568809655
Name:GREGG, TERRI L (SLP, MS/CCC)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:L
Last Name:GREGG
Suffix:
Gender:F
Credentials:SLP, MS/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 HIGHLAND AVE
Mailing Address - Street 2:HIGHLAND ELEMENTARY
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2964
Mailing Address - Country:US
Mailing Address - Phone:509-758-5531
Mailing Address - Fax:
Practice Address - Street 1:1432 HIGHLAND AVE
Practice Address - Street 2:HIGHLAND ELEMENTARY
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2964
Practice Address - Country:US
Practice Address - Phone:509-758-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60338905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist