Provider Demographics
NPI:1851311013
Name:GREGORY, MARYANN L (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:L
Last Name:GREGORY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 N DEARBORN ST
Mailing Address - Street 2:4N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1558
Mailing Address - Country:US
Mailing Address - Phone:312-203-9877
Mailing Address - Fax:312-782-7001
Practice Address - Street 1:11 S LA SALLE ST
Practice Address - Street 2:#2600
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1203
Practice Address - Country:US
Practice Address - Phone:312-203-9877
Practice Address - Fax:312-283-7001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist