Provider Demographics
NPI:1922048909
Name:LAMP, GREGORY LEE SR (MS CCCA)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LEE
Last Name:LAMP
Suffix:SR
Gender:M
Credentials:MS CCCA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6597
Mailing Address - Street 2:716 SOUTH MAIN
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-6597
Mailing Address - Country:US
Mailing Address - Phone:918-786-5544
Mailing Address - Fax:918-786-5710
Practice Address - Street 1:716 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-6597
Practice Address - Country:US
Practice Address - Phone:918-786-5544
Practice Address - Fax:918-786-5710
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK161231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100666250DMedicaid
OK100810190AMedicaid