Healthcare Provider Details

I. General information

NPI: 1316286545
Provider Name (Legal Business Name): DERRICK BRETT KRETSCHMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 S MASON AVE APT 7E
TACOMA WA
98409-8535
US

IV. Provider business mailing address

2367 TACOMA AVE S # 102
TACOMA WA
98402-1409
US

V. Phone/Fax

Practice location:
  • Phone: 661-220-4947
  • Fax:
Mailing address:
  • Phone: 253-398-4765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number70144094
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: