Basic Information
| Provider Information | |||||||||
| NPI: | 1013257393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | GREGGORY | ||||||||
| MiddleName: | LEWIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.A., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 SUNNY LN | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178219464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178504141 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 64 REHAB LANE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716110 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2013 | ||||||||
| LastUpdateDate: | 12/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2013005278 | MO | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SL011842 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.