Provider Demographics
NPI:1144356940
Name:PERRETZ ROSALES, GRISELDA S (PHD)
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:S
Last Name:PERRETZ ROSALES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4065
Mailing Address - Country:US
Mailing Address - Phone:360-943-2555
Mailing Address - Fax:360-352-2513
Practice Address - Street 1:1026 STATE ST
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4065
Practice Address - Country:US
Practice Address - Phone:360-943-2555
Practice Address - Fax:360-352-2513
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1395103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist