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NPI Code Detail

MEDICARE: JACOB MICHAEL GEREND

MEDICARE:   JACOB MICHAEL GEREND
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1972371821
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB MICHAEL GEREND
Provider Business Mailing Address
First Line : 2159 DELAWARE AVE
Second Line :
City : MENDOTA HEIGHTS
State : MN
Zip : 55118-4803
Country : US
Telephone Number : 612-889-9707
Fax Number :
Provider Business Practice Location Address
First Line : 7525 VILLAGE DR STE 130
Second Line :
City : LINO LAKES
State : MN
Zip : 55014-1305
Country : US
Telephone Number : 612-889-9707
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2023
Last Update Date : 12/19/2023

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Directions to “ JACOB MICHAEL GEREND ” Practice Location

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