Provider Demographics
NPI:1245343847
Name:GREGG, ANDREA RENEE (SLP)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:RENEE
Last Name:GREGG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-7245
Mailing Address - Fax:314-362-7346
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:DEPT OTOLARYNGOLOGY, 8TH FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-7245
Practice Address - Fax:314-362-7346
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008008118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO460013754Medicaid
ILENROLLEDMedicaid