Provider Demographics
NPI:1174795728
Name:GREGORY, GARY LEE (ACA)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:GREGORY
Suffix:
Gender:M
Credentials:ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MALABU DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3143
Mailing Address - Country:US
Mailing Address - Phone:859-278-7212
Mailing Address - Fax:859-277-3313
Practice Address - Street 1:121 MALABU DR
Practice Address - Street 2:SUITE #3
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3143
Practice Address - Country:US
Practice Address - Phone:859-278-7212
Practice Address - Fax:859-277-3313
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY626237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist