Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PY2060 | WA |
N | 103TR0400X | Rehabilitation Psychologist | 1287 | OR |
NPI | 1588642953 |
---|---|
Provider Name | Dr. Joseph Peter Gretsch |
First Address | Portland, OR 97204-2405 |
Second Address | Portland, OR 97204-2405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 12/01/2012 |