Provider Demographics
NPI:1316789811
Name:ADAMS-GREGORY, BIANCA
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:ADAMS-GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 SW ORBIT ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3065
Mailing Address - Country:US
Mailing Address - Phone:404-784-4855
Mailing Address - Fax:
Practice Address - Street 1:3806 SW ORBIT ST UNIT 309
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3065
Practice Address - Country:US
Practice Address - Phone:404-784-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist