Provider Demographics
NPI:1154579266
Name:BAILEY, GRETCHEN LENORE (LMP)
Entity type:Individual
Prefix:MS
First Name:GRETCHEN
Middle Name:LENORE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 S. 11TH ST. STE 15A
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4099
Mailing Address - Country:US
Mailing Address - Phone:253-272-1825
Mailing Address - Fax:253-272-0573
Practice Address - Street 1:1206 S. 11TH ST. STE 15A
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4099
Practice Address - Country:US
Practice Address - Phone:253-272-1825
Practice Address - Fax:253-272-0573
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021812225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist