1487649893 NPI number — DR. ELLEN MEYER GREGG PH.D., CCC-SLP

Table of content: MS. SHERYN LYNNELL ATKINSON RN (NPI 1285252387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487649893 NPI number — DR. ELLEN MEYER GREGG PH.D., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGG
Provider First Name:
ELLEN
Provider Middle Name:
MEYER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEYER
Provider Other First Name:
MARY
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CCC-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487649893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1332 51ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREELEY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80634-2123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-356-6132
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNC SPEECH AND AUDIOLOGY CLINIC
Provider Second Line Business Practice Location Address:
GUNTER HALL ROOM 0330
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80639-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-351-2012
Provider Business Practice Location Address Fax Number:
970-351-2974
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  00542688 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07542681 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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