Provider Demographics
NPI:1710657994
Name:MATTHEWS, GRETCHEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SW BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-9360
Mailing Address - Country:US
Mailing Address - Phone:360-443-3741
Mailing Address - Fax:
Practice Address - Street 1:500 SW BIRCH RD
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-9360
Practice Address - Country:US
Practice Address - Phone:360-443-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist