Provider Demographics
NPI:1548699630
Name:GREATHOUSE, GENA CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:GENA
Middle Name:CHRISTINE
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:GENA
Other - Middle Name:CHRISTINE
Other - Last Name:WOOLDRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 COUNTY ROAD 4809
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:TX
Mailing Address - Zip Code:75551-8512
Mailing Address - Country:US
Mailing Address - Phone:903-799-8983
Mailing Address - Fax:
Practice Address - Street 1:902 ABC LN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:TX
Practice Address - Zip Code:75551-2453
Practice Address - Country:US
Practice Address - Phone:903-796-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-08
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113559235Z00000X
NM5250235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist