Healthcare Provider Details

I. General information

NPI: 1609923721
Provider Name (Legal Business Name): MICHELE L. GERARD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 30TH ST # 224
BOULDER CO
80301-1029
US

IV. Provider business mailing address

1750 30TH ST # 224
BOULDER CO
80301-1029
US

V. Phone/Fax

Practice location:
  • Phone: 303-939-9650
  • Fax: 303-939-9677
Mailing address:
  • Phone: 303-939-9650
  • Fax: 303-939-9677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1265
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number10251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: