Provider Demographics
NPI:1982801635
Name:GREGG, SONYA ESME (CPM, LDM)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:ESME
Last Name:GREGG
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1983 NW FLANDERS ST APT 403
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2046
Mailing Address - Country:US
Mailing Address - Phone:503-320-8017
Mailing Address - Fax:
Practice Address - Street 1:19255 SW 65TH AVE STE 220
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9717
Practice Address - Country:US
Practice Address - Phone:503-885-0228
Practice Address - Fax:503-691-9455
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1001281176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife