Provider Demographics
NPI:1104367325
Name:PLEUSS, GRETCHEN (PUPIL PERSONNEL SERV)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:PLEUSS
Suffix:
Gender:F
Credentials:PUPIL PERSONNEL SERV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 S CHAPEL AVE APT D
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4412
Mailing Address - Country:US
Mailing Address - Phone:808-343-8216
Mailing Address - Fax:
Practice Address - Street 1:723 S CHAPEL AVE APT D
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4412
Practice Address - Country:US
Practice Address - Phone:808-343-8216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140053442405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional