Healthcare Provider Details

I. General information

NPI: 1316614548
Provider Name (Legal Business Name): MICHAEL JAMES GREGG LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 03/13/2024
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 N MILL ST STE B
NAPERVILLE IL
60563-4872
US

IV. Provider business mailing address

106 S LINCOLNWAY
NORTH AURORA IL
60542-1663
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-2344
  • Fax:
Mailing address:
  • Phone: 630-801-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150.110571
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: