Provider Demographics
NPI:1891254058
Name:GENDREAU, GRETCHEN S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:S
Last Name:GENDREAU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 43RD ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4280
Mailing Address - Country:US
Mailing Address - Phone:253-218-9912
Mailing Address - Fax:
Practice Address - Street 1:426 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8636
Practice Address - Country:US
Practice Address - Phone:253-256-6594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60968000103T00000X, 103TC1900X
WAMHCA.MC.60930549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling