Provider Demographics
NPI:1083183107
Name:PRETZER, GINA MARIE (SLP)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:PRETZER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2091
Mailing Address - Country:US
Mailing Address - Phone:253-565-4484
Mailing Address - Fax:253-565-5823
Practice Address - Street 1:6424 N 9TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2091
Practice Address - Country:US
Practice Address - Phone:253-565-4484
Practice Address - Fax:253-565-5823
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL60871369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-0598103OtherTAX ID