Provider Demographics
NPI:1487830519
Name:SASS, GRETCHEN (LAC)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:SASS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MILKY WAY DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674-9325
Mailing Address - Country:US
Mailing Address - Phone:503-522-1557
Mailing Address - Fax:
Practice Address - Street 1:1925 BELMONT LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-8487
Practice Address - Country:US
Practice Address - Phone:360-225-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003067171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist