Provider Demographics
NPI:1578903332
Name:KOPP, GRETCHEN LORRAINE (BS/AAC)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LORRAINE
Last Name:KOPP
Suffix:
Gender:F
Credentials:BS/AAC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:LORRAINE
Other - Last Name:ROHLFS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5301 TIETON DRIVE, SUITE C
Mailing Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3478
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:509-966-9750
Practice Address - Street 1:5301 TIETON DRIVE, SUITE C
Practice Address - Street 2:C/O CATHOLIC FAMILY & CHILD SERVICE
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3478
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:509-966-9750
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG6021699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health