Provider Demographics
NPI:1861575243
Name:MCGREGOR, KATHLEEN J (MA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:J
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 RIVER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4875
Mailing Address - Country:US
Mailing Address - Phone:698-501-2778
Mailing Address - Fax:770-995-9557
Practice Address - Street 1:250 LANGLEY DR
Practice Address - Street 2:SUITE 1312
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-6932
Practice Address - Country:US
Practice Address - Phone:770-995-3479
Practice Address - Fax:770-995-9557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000744SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000547368BMedicaid