Provider Demographics
NPI:1245014372
Name:WORTMAN, GRETCHEN MICHELLE
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MICHELLE
Last Name:WORTMAN
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 1:1100 WASHINGTON AVE STE 317
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-3617
Mailing Address - Country:US
Mailing Address - Phone:412-439-7572
Mailing Address - Fax:
Practice Address - Street 1:1100 WASHINGTON AVE STE 317
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-3617
Practice Address - Country:US
Practice Address - Phone:412-439-7572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA017194235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist