Provider Demographics
NPI:1679636658
Name:LAFOLLETTE, GRETCHEN RUTH (RC)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:RUTH
Last Name:LAFOLLETTE
Suffix:
Gender:F
Credentials:RC
Other - Prefix:MS
Other - First Name:GRETCHEN
Other - Middle Name:RUTH
Other - Last Name:JUNKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SEATTLE MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:505 29TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7541
Practice Address - Country:US
Practice Address - Phone:253-876-7650
Practice Address - Fax:253-876-7651
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00039337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional