Provider Demographics
NPI:1225889140
Name:MONDRAGON, GLADYS RUBY
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:RUBY
Last Name:MONDRAGON
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 1:315 N G ST APT 104
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2208
Mailing Address - Country:US
Mailing Address - Phone:253-332-3202
Mailing Address - Fax:
Practice Address - Street 1:1701 13TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4707
Practice Address - Country:US
Practice Address - Phone:253-848-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor