Provider Demographics
NPI:1952463002
Name:GREGG, GARY R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:GREGG
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:890 ELM GROVE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2528
Mailing Address - Country:US
Mailing Address - Phone:262-780-0991
Mailing Address - Fax:262-780-0992
Practice Address - Street 1:890 ELM GROVE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2528
Practice Address - Country:US
Practice Address - Phone:262-780-0991
Practice Address - Fax:262-780-0992
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical