Provider Demographics
NPI:1194026138
Name:CHARLTON, GRETCHEN ELIZABETH (BSQMHA)
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:CHARLTON
Suffix:
Gender:F
Credentials:BSQMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 VANDENBERG RD
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-3730
Mailing Address - Country:US
Mailing Address - Phone:541-882-7291
Mailing Address - Fax:541-883-4213
Practice Address - Street 1:3314 VANDENBERG RD
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-3730
Practice Address - Country:US
Practice Address - Phone:541-882-7291
Practice Address - Fax:541-883-4213
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator