Provider Demographics
NPI:1740766336
Name:SMITH GRETSKY, KATRINA ELAINA (AUD)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:ELAINA
Last Name:SMITH GRETSKY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:ELAINA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1001 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2789
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2789
Practice Address - Country:US
Practice Address - Phone:315-428-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002810-1231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist