Provider Demographics
NPI:1598832131
Name:POGUE, GRETCHEN WOODS
Entity Type:Individual
Prefix:MRS
First Name:GRETCHEN
Middle Name:WOODS
Last Name:POGUE
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 1:5855 WILLOW OAK PASS
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-7506
Mailing Address - Country:US
Mailing Address - Phone:407-415-3208
Mailing Address - Fax:
Practice Address - Street 1:3985 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9448
Practice Address - Country:US
Practice Address - Phone:404-966-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8444235Z00000X
GASLP008127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL155583404OtherTRICARE
FLS9318OtherBCBS OF FLORIDA
FL891565200Medicaid
FL000851900Medicaid