Provider Demographics
NPI:1891115440
Name:KRYSS-PEAK, GRETCHEN
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:KRYSS-PEAK
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 1:12607 SEMILL PLAIN BLVD
Mailing Address - Street 2:DEPARTMENT OF MENTAL HEALTH
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6055
Mailing Address - Country:US
Mailing Address - Phone:650-296-6978
Mailing Address - Fax:
Practice Address - Street 1:12607 SEMILL PLAIN BLVD
Practice Address - Street 2:DEPARTMENT OF MENTAL HEALTH
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:650-296-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30583103T00000X
OR3407103T00000X
251S00000X
WAPY61222117103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No251S00000XAgenciesCommunity/Behavioral Health