Provider Demographics
NPI:1275805947
Name:PRICE, GRETCHEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 BEVERLY PIKE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9759
Mailing Address - Country:US
Mailing Address - Phone:304-636-1391
Mailing Address - Fax:304-636-1371
Practice Address - Street 1:1175 BEVERLY PIKE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9759
Practice Address - Country:US
Practice Address - Phone:304-636-1391
Practice Address - Fax:304-636-1371
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1559235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist