Healthcare Provider Details

I. General information

NPI: 1477463339
Provider Name (Legal Business Name): GRETA GAZDA-ROE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70805 TWIN BEECH RD
BRIDGEPORT OH
43912-7710
US

IV. Provider business mailing address

70805 TWIN BEECH RD
BRIDGEPORT OH
43912-7710
US

V. Phone/Fax

Practice location:
  • Phone: 304-281-7938
  • Fax:
Mailing address:
  • Phone: 304-281-7938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2614439
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: