MEDICARE: DR. CLARICE KARINE GERKE PH.D.

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	103TC0700X	Clinical Psychologist	0810004008	VA
2	103TC0700X	Clinical Psychologist	2011000215	MO

General Provider Information

NPI Number	:	1497051411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARICE KARINE GERKE PH.D.

Provider Business Mailing Address
First Line	:	5505 ROSA AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-3249
Country	:	US
Telephone Number	:	314-210-3869
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 HUBER PARK CT STE 205
Second Line	:
City	:	WELDON SPRING
State	:	MO
Zip	:	63304-8683
Country	:	US
Telephone Number	:	636-300-9922
Fax Number	:

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

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	03/17/2021

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