Provider Demographics
NPI:1922579853
Name:GREGORY, MARIAN FRANCES
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:FRANCES
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 THOMPSON CREEK RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2514
Mailing Address - Country:US
Mailing Address - Phone:410-490-9972
Mailing Address - Fax:
Practice Address - Street 1:110 ELEMENTARY WAY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-4027
Practice Address - Country:US
Practice Address - Phone:410-643-2392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00607Medicaid