Provider Demographics
NPI:1437873072
Name:KLOCKEMAN, GECHELLE
Entity Type:Individual
Prefix:
First Name:GECHELLE
Middle Name:
Last Name:KLOCKEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GECHELLE
Other - Middle Name:
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:135 167TH ST E
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8262
Mailing Address - Country:US
Mailing Address - Phone:253-353-5056
Mailing Address - Fax:
Practice Address - Street 1:21120 MERIDIAN E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8254
Practice Address - Country:US
Practice Address - Phone:253-285-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty