Provider Demographics
NPI:1629239769
Name:GIRTEN, GREGORY K (MS CCC-A)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:K
Last Name:GIRTEN
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4303
Mailing Address - Country:US
Mailing Address - Phone:228-257-0175
Mailing Address - Fax:
Practice Address - Street 1:745 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-4303
Practice Address - Country:US
Practice Address - Phone:228-424-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA3277231H00000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1047AOtherALABAMA LICENSE