Provider Demographics
NPI:1720725328
Name:GREGORY, CHARLENE MARIE (HIS)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:MARIE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:MARIE
Other - Last Name:TROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421
Mailing Address - Country:US
Mailing Address - Phone:315-363-7869
Mailing Address - Fax:315-363-4661
Practice Address - Street 1:121 MAIN ST.
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421
Practice Address - Country:US
Practice Address - Phone:315-363-7869
Practice Address - Fax:315-363-4661
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000068067237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist