Provider Demographics
NPI:1386144806
Name:TUCKER, GRETCHEN (MA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 ADAMS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-2404
Mailing Address - Country:US
Mailing Address - Phone:267-420-2074
Mailing Address - Fax:
Practice Address - Street 1:1100 ADAMS AVE FL 1
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-2404
Practice Address - Country:US
Practice Address - Phone:267-420-2074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
PAPC013844101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional