Provider Demographics
NPI:1801023304
Name:WEBBER, GRETCHEN MIEKE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:MIEKE
Last Name:WEBBER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MRS
Other - First Name:GRETCHEN
Other - Middle Name:MIEKE
Other - Last Name:VAN MIDDLESWORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:21614 SCANNEL AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6243
Mailing Address - Country:US
Mailing Address - Phone:310-352-6405
Mailing Address - Fax:310-356-3682
Practice Address - Street 1:18726 S WESTERN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3813
Practice Address - Country:US
Practice Address - Phone:310-352-6405
Practice Address - Fax:310-356-3682
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11495235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist