Provider Demographics
NPI:1487494969
Name:GREGORYK, STEFANIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:GREGORYK
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 1:640 SUPERIOR CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6181
Mailing Address - Country:US
Mailing Address - Phone:541-816-0370
Mailing Address - Fax:
Practice Address - Street 1:640 SUPERIOR CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6181
Practice Address - Country:US
Practice Address - Phone:541-816-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18107235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist