Provider Demographics
NPI:1558732941
Name:GATDULA, GLAIZA
Entity Type:Individual
Prefix:
First Name:GLAIZA
Middle Name:
Last Name:GATDULA
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 1:228 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4936
Mailing Address - Country:US
Mailing Address - Phone:253-339-9657
Mailing Address - Fax:
Practice Address - Street 1:228 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4936
Practice Address - Country:US
Practice Address - Phone:253-339-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor