Provider Demographics
NPI:1578549796
Name:HESSLER, GRETCHEN M (MA)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:HESSLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:M
Other - Last Name:SPAETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12540 COUNTY ROAD 7060
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-5952
Mailing Address - Country:US
Mailing Address - Phone:573-647-1676
Mailing Address - Fax:
Practice Address - Street 1:12540 COUNTY ROAD 7060
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-5952
Practice Address - Country:US
Practice Address - Phone:573-647-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493586739Medicaid