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General NPI Number Information
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NPI Number | 1962856310
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Entity Type | Individual
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Provider Name | PATRICIA GREGORY LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 01/31/2019
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Provider Practice Location Address
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Address Line | 5090 HUMBERT RD
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City | ALTON
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State | IL
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Zip | 62002
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Country | US
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Telephone | 618-466-0295
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Fax | 618-551-2676
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Provider Business Mailing Address
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Address Line | PO BOX 786
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City | GODFREY
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State | IL
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Zip | 62035-0786
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Country | US
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Telephone | 618-664-0295
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Fax | 618-551-2676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.016663
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License Number State | IL
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