Provider Demographics
NPI:1679304141
Name:GREGORY, GRACE EMILY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:EMILY
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 HIGHLAND AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1436
Mailing Address - Country:US
Mailing Address - Phone:636-236-6225
Mailing Address - Fax:
Practice Address - Street 1:102A MITCHELL RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7918
Practice Address - Country:US
Practice Address - Phone:865-213-2844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist