Individual
GREGORY STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
705 S MAIN ST, SUITE 220, PLYMOUTH, MI 48170-2089
(773) 549-5294
Mailing address
705 S MAIN ST, SUITE 220, PLYMOUTH, MI 48170-2089
(773) 549-5294
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146010622
IL
Other
Enumeration date
11/09/2011
Last updated
11/09/2011
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