Provider Demographics
NPI:1184068983
Name:GREGOIRE, ELISE
Entity type:Individual
Prefix:DR
First Name:ELISE
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:NEUKOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5825 THORNHILL DR APT 5
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2155
Mailing Address - Country:US
Mailing Address - Phone:952-322-0929
Mailing Address - Fax:
Practice Address - Street 1:3017 TELEGRAPH AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2049
Practice Address - Country:US
Practice Address - Phone:952-322-0929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9016237600000X
CA2925237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter