Healthcare Provider Details

I. General information

NPI: 1700753977
Provider Name (Legal Business Name): GERAD SLAYTON CHW, CMPSS, BCST,MHF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GERAD AMORE

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CALAVERAS AVE
MODESTO CA
95354-3621
US

IV. Provider business mailing address

110 WISENOR AVE SPC 19
MODESTO CA
95351-4058
US

V. Phone/Fax

Practice location:
  • Phone: 209-241-1625
  • Fax:
Mailing address:
  • Phone: 209-241-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-NGBECZ
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberMPSS-NGBECZ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: