Provider Demographics
NPI:1013074194
Name:GREGG, JEANNE A (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:A
Last Name:GREGG
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:A
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:578 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILOMATH
Mailing Address - State:OR
Mailing Address - Zip Code:97370-9304
Mailing Address - Country:US
Mailing Address - Phone:541-602-4112
Mailing Address - Fax:541-715-3770
Practice Address - Street 1:1229 MAIN ST.
Practice Address - Street 2:SUITE 105
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9304
Practice Address - Country:US
Practice Address - Phone:541-602-4112
Practice Address - Fax:541-714-3770
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L40971041C0700X
OR40971041C0700X
ORL40971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical