Provider Demographics
NPI:1609075852
Name:MARGART, GREGORY DOLEGLAS (MA SLP)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DOLEGLAS
Last Name:MARGART
Suffix:
Gender:M
Credentials:MA SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1261
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-1261
Mailing Address - Country:US
Mailing Address - Phone:707-444-3008
Mailing Address - Fax:707-444-8053
Practice Address - Street 1:737 7TH STREET
Practice Address - Street 2:SUITE O
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-444-3008
Practice Address - Fax:707-444-8053
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP7353235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASP0073530Medicaid