Provider Demographics
NPI:1952089377
Name:GREGORY, JEAN-MICHELE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JEAN-MICHELE
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 1:1028 S 61ST ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-3301
Mailing Address - Country:US
Mailing Address - Phone:917-322-9220
Mailing Address - Fax:
Practice Address - Street 1:142 JORALEMON ST
Practice Address - Street 2:STE 3ABC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4747
Practice Address - Country:US
Practice Address - Phone:718-522-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030416-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist