Provider Demographics
NPI:1902697972
Name:SMITH VAZQUEZ, GRETCHEN LEIGH (BCBA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LEIGH
Last Name:SMITH VAZQUEZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2663 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3197
Mailing Address - Country:US
Mailing Address - Phone:303-362-3827
Mailing Address - Fax:
Practice Address - Street 1:2663 SHAWNEE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3197
Practice Address - Country:US
Practice Address - Phone:303-362-3827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO757360103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst