Provider Demographics
NPI:1194290817
Name:SMITH, GRETCHEN (MSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 N SHIRLEY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98407-6599
Mailing Address - Country:US
Mailing Address - Phone:253-507-7231
Mailing Address - Fax:
Practice Address - Street 1:7610 40TH ST W STE 300
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-3834
Practice Address - Country:US
Practice Address - Phone:253-507-7231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor