Provider Demographics
NPI:1194719005
Name:DELDUCA, GREGORY CHARLES JR (MA, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:CHARLES
Last Name:DELDUCA
Suffix:JR
Gender:M
Credentials:MA, CCC-SLP
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Mailing Address - Street 1:1114 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-1334
Mailing Address - Country:US
Mailing Address - Phone:412-427-3313
Mailing Address - Fax:724-871-1388
Practice Address - Street 1:1525 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-1339
Practice Address - Country:US
Practice Address - Phone:412-559-1392
Practice Address - Fax:724-871-1388
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2016-05-27
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Provider Licenses
StateLicense IDTaxonomies
PASL005935L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019924660001Medicaid