Provider Demographics
NPI:1841838604
Name:LAMM, GRETCHEN ANNE (LLP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANNE
Last Name:LAMM
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:ANNE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:5582 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9429
Mailing Address - Country:US
Mailing Address - Phone:269-365-2925
Mailing Address - Fax:
Practice Address - Street 1:4341 S WESTNEDGE AVE STE 1205
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3284
Practice Address - Country:US
Practice Address - Phone:248-600-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361000304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty