Provider Demographics
NPI:1891431813
Name:STEPHENS, GRETCHEN (MS CCC/SLP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP
Mailing Address - Street 1:3011 E WATT RD
Mailing Address - Street 2:
Mailing Address - City:SPANGLE
Mailing Address - State:WA
Mailing Address - Zip Code:99031-9767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12414 S ANDRUS RD
Practice Address - Street 2:
Practice Address - City:CHENEY
Practice Address - State:WA
Practice Address - Zip Code:99004-8607
Practice Address - Country:US
Practice Address - Phone:509-559-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL0004649235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist