Provider Demographics
NPI:1740702273
Name:PULLIAM, GRETCHEN MICHELLE
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:MICHELLE
Last Name:PULLIAM
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 1:114 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-6308
Mailing Address - Country:US
Mailing Address - Phone:409-673-8107
Mailing Address - Fax:
Practice Address - Street 1:415 HIGHWAY 327 W
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-4799
Practice Address - Country:US
Practice Address - Phone:409-980-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist