Provider Demographics
NPI:1942319785
Name:CARLSON, GRETCHEN WOODWORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:WOODWORTH
Last Name:CARLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 114TH AVE SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6942
Mailing Address - Country:US
Mailing Address - Phone:425-454-2835
Mailing Address - Fax:425-454-2315
Practice Address - Street 1:1300 114TH AVE SE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6942
Practice Address - Country:US
Practice Address - Phone:425-454-2835
Practice Address - Fax:425-454-2315
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000392002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry