Provider Demographics
NPI:1871229674
Name:ZAJAC, GREGORY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:ZAJAC
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 HILL RD N
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7989
Mailing Address - Country:US
Mailing Address - Phone:614-604-6067
Mailing Address - Fax:
Practice Address - Street 1:1241 HILL RD N
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7989
Practice Address - Country:US
Practice Address - Phone:614-604-6067
Practice Address - Fax:614-604-6529
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND20211871DP235Z00000X
OHSP.15067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist