MEDICARE: KATHARINE GREGG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2200637A	IN

General Provider Information

NPI Number	:	1528525490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHARINE GREGG

Provider Business Mailing Address
First Line	:	2006 EDITH AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-2288
Country	:	US
Telephone Number	:	260-609-1976
Fax Number	:

Provider Business Practice Location Address
First Line	:	2006 EDITH AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46808-2288
Country	:	US
Telephone Number	:	260-609-1976
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	02/26/2019

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Directions to “ KATHARINE GREGG ” Practice Location

Language	Start Address	Practice Location

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