Provider Demographics
NPI:1114359627
Name:RIVERA, GRETCHEN ADLIN
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ADLIN
Last Name:RIVERA
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:P.O. BOX 9217
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00613
Mailing Address - Country:UM
Mailing Address - Phone:787-566-7349
Mailing Address - Fax:
Practice Address - Street 1:URB. HACIENDA TOLEDO C60
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00612
Practice Address - Country:UM
Practice Address - Phone:787-566-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist