Provider Demographics
NPI:1184009953
Name:KREBS, GRETCHEN (BACB, MS)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:KREBS
Suffix:
Gender:F
Credentials:BACB, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3344
Mailing Address - Country:US
Mailing Address - Phone:385-220-5488
Mailing Address - Fax:
Practice Address - Street 1:1935 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-3344
Practice Address - Country:US
Practice Address - Phone:385-220-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst