MEDICARE: MS. GRETCHEN MIEKE WEBBER CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	11495	CA

General Provider Information

NPI Number	:	1801023304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRETCHEN MIEKE WEBBER CCC-SLP

Provider Business Mailing Address
First Line	:	21614 SCANNEL AVE
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90503-6243
Country	:	US
Telephone Number	:	310-352-6405
Fax Number	:	310-356-3682

Provider Business Practice Location Address
First Line	:	18726 S WESTERN AVE
Second Line	:	SUITE 204
City	:	GARDENA
State	:	CA
Zip	:	90248-3813
Country	:	US
Telephone Number	:	310-352-6405
Fax Number	:	310-356-3682

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	07/29/2013

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Directions to “ MS. GRETCHEN MIEKE WEBBER CCC-SLP” Practice Location

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