Provider Demographics
NPI:1326819889
Name:BLUM, GRETCHEN LINDA CAROL
Entity Type:Individual
Prefix:
First Name:GRETCHEN LINDA
Middle Name:CAROL
Last Name:BLUM
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 1:10935 CHERRY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9645
Mailing Address - Country:US
Mailing Address - Phone:707-536-3218
Mailing Address - Fax:
Practice Address - Street 1:10935 CHERRY RIDGE RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9645
Practice Address - Country:US
Practice Address - Phone:707-536-3218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty