Provider Demographics
NPI:1669540639
Name:CUNNINGHAM, GRETCHEN I (LMP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:I
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:I
Other - Last Name:FLEWELLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:226 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2338
Mailing Address - Country:US
Mailing Address - Phone:509-475-4835
Mailing Address - Fax:
Practice Address - Street 1:3430 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2621
Practice Address - Country:US
Practice Address - Phone:509-475-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018558225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0180257OtherLABOR AND INDUSTRIES