Provider Demographics
NPI:1659778256
Name:COOLIDGE, GREGORY CARLETON II (CHWC, CFNS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CARLETON
Last Name:COOLIDGE
Suffix:II
Gender:M
Credentials:CHWC, CFNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 LITTLE ROUND TOP
Mailing Address - Street 2:#315
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4417
Mailing Address - Country:US
Mailing Address - Phone:859-757-7060
Mailing Address - Fax:
Practice Address - Street 1:240 LITTLE ROUND TOP
Practice Address - Street 2:#315
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4417
Practice Address - Country:US
Practice Address - Phone:859-757-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator