Healthcare Provider Details

I. General information

NPI: 1659948354
Provider Name (Legal Business Name): GLORIA GREGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 LILA AVE
MILFORD OH
45150-1683
US

IV. Provider business mailing address

1452 BETHEL NEW RICHMOND RD
NEW RICHMOND OH
45157-9564
US

V. Phone/Fax

Practice location:
  • Phone: 513-900-9578
  • Fax:
Mailing address:
  • Phone: 513-616-5052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: