Provider Demographics
NPI:1285224212
Name:PANGILINAN, GRETCHEN LARUE (MA)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LARUE
Last Name:PANGILINAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1120
Mailing Address - Country:US
Mailing Address - Phone:303-817-9598
Mailing Address - Fax:
Practice Address - Street 1:3005 47TH ST STE F4
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5550
Practice Address - Country:US
Practice Address - Phone:303-295-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist