Individual
DR. GRETCHEN RANDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D, PMHNP
Contact information
Practice address
13635 SW 115TH AVE, TIGARD, OR 97223-2862
(503) 968-1155
Mailing address
13635 SW 115TH AVE, TIGARD, OR 97223-2862
(503) 968-1155
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
S80045119NG
OR
Other
Enumeration date
10/14/2008
Last updated
10/14/2008
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