Provider Demographics
NPI:1356020788
Name:GRETCHEN VAN WINKLE LICSW PLLC
Entity type:Organization
Organization Name:GRETCHEN VAN WINKLE LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN WINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-276-9863
Mailing Address - Street 1:46 BARRISTER DR UNIT D
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-5503
Mailing Address - Country:US
Mailing Address - Phone:603-276-9863
Mailing Address - Fax:
Practice Address - Street 1:46 BARRISTER DR UNIT D
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-5503
Practice Address - Country:US
Practice Address - Phone:603-276-9863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty