Provider Demographics
NPI:1235549130
Name:SCHLICHT, GRETCHEN (AT/L)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:SCHLICHT
Suffix:
Gender:F
Credentials:AT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 S PASEO LOMA
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6477
Mailing Address - Country:US
Mailing Address - Phone:480-456-6447
Mailing Address - Fax:
Practice Address - Street 1:2033 S PASEO LOMA
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6477
Practice Address - Country:US
Practice Address - Phone:480-456-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ000292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ00029OtherATHLETIC TRAINER