Provider Demographics
NPI:1669629382
Name:MARTINDALE, GWENDOLYN ANNE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ANNE
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87147
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98687-7147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 SE PARK CREST AVE
Practice Address - Street 2:APT. R-198
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-8332
Practice Address - Country:US
Practice Address - Phone:360-624-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator