Provider Demographics
NPI:1255720561
Name:GREGORY, JENNIFER DYAN (MA)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DYAN
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E 86TH ST
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1859
Mailing Address - Country:US
Mailing Address - Phone:317-910-9019
Mailing Address - Fax:
Practice Address - Street 1:921 E 86TH ST
Practice Address - Street 2:SUITE 210B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1859
Practice Address - Country:US
Practice Address - Phone:317-910-9019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health