Provider Demographics
NPI:1609076819
Name:NORDLOH, GREGORY EDWARD (PHD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:EDWARD
Last Name:NORDLOH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EAST LIBERTY STREET
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-582-7484
Mailing Address - Fax:502-582-7646
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY FL 6
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-582-7484
Practice Address - Fax:502-582-7646
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
KY130825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006181Medicaid
KYK252480OtherMEDICARE
KY7100479880Medicaid
KYP01922742OtherRR MEDICARE