Provider Demographics
NPI:1811316920
Name:GREGORY, ALI (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ALI
Middle Name:
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 W LOVERS LANE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:MO
Mailing Address - Zip Code:63555-1802
Mailing Address - Country:US
Mailing Address - Phone:660-465-8532
Mailing Address - Fax:
Practice Address - Street 1:438 W LOVERS LANE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:MO
Practice Address - Zip Code:63555-1802
Practice Address - Country:US
Practice Address - Phone:660-465-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1013027348235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist