Provider Demographics
NPI:1659648905
Name:THOMPSON, GRETCHEN ANN
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANN
Last Name:THOMPSON
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 1:411 30TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3310
Mailing Address - Country:US
Mailing Address - Phone:510-486-8007
Mailing Address - Fax:
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3310
Practice Address - Country:US
Practice Address - Phone:510-486-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator