Provider Demographics
NPI:1104859255
Name:RINEHART, GRETCHEN L
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:L
Last Name:RINEHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9612 HUNTING GROUND CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228-2485
Mailing Address - Country:US
Mailing Address - Phone:502-876-4184
Mailing Address - Fax:502-780-5898
Practice Address - Street 1:8011 NEW LA GRANGE RD STE 7
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4781
Practice Address - Country:US
Practice Address - Phone:502-876-4184
Practice Address - Fax:502-780-5898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20301041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0938423Medicare ID - Type Unspecified