Healthcare Provider Details

I. General information

NPI: 1114836780
Provider Name (Legal Business Name): KATELYN RENAE GREGORICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 GRANDVIEW RD
ALEXANDER NC
28701-9634
US

IV. Provider business mailing address

21 GREENRIDGE RD
WEAVERVILLE NC
28787-8325
US

V. Phone/Fax

Practice location:
  • Phone: 224-500-7518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30005139
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: