Provider Demographics
NPI:1811344385
Name:KREGER, KACY LANE (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KACY
Middle Name:LANE
Last Name:KREGER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:201 WINDING RD APT 2301
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-1136
Mailing Address - Country:US
Mailing Address - Phone:904-229-6830
Mailing Address - Fax:
Practice Address - Street 1:69 LINDSEY LN STE A
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-1702
Practice Address - Country:US
Practice Address - Phone:912-729-2294
Practice Address - Fax:912-673-9457
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
FLSA15431235Z00000X
235Z00000X
GASLP012263235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist