Healthcare Provider Details

I. General information

NPI: 1669652657
Provider Name (Legal Business Name): SUSAN D GIEROK PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 S AUSTRALIAN AVE SUITE 205
WEST PALM BEACH FL
33409-6450
US

IV. Provider business mailing address

1800 S AUSTRALIAN AVE SUITE 205
WEST PALM BEACH FL
33409-6450
US

V. Phone/Fax

Practice location:
  • Phone: 561-317-9955
  • Fax: 561-689-0806
Mailing address:
  • Phone: 561-317-9955
  • Fax: 561-689-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1334
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: