Provider Demographics
NPI:1841179017
Name:GILLINGHAM, GRETCHEN GYVING (PHD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:GYVING
Last Name:GILLINGHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4898 TALTEC DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4470
Mailing Address - Country:US
Mailing Address - Phone:619-804-5648
Mailing Address - Fax:
Practice Address - Street 1:3754 CLAIREMONT DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5916
Practice Address - Country:US
Practice Address - Phone:619-276-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20163103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist