Provider Demographics
NPI:1487956314
Name:ANDERSON, GRETCHEN M (MSW)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:ANDERSON
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 1:566 ANN ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1724
Mailing Address - Country:US
Mailing Address - Phone:248-646-1803
Mailing Address - Fax:
Practice Address - Street 1:566 ANN ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1724
Practice Address - Country:US
Practice Address - Phone:248-646-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010578041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical