Healthcare Provider Details

I. General information

NPI: 1710803903
Provider Name (Legal Business Name): MS. GENEVIEVE CARLENE GEHRING-GERVASE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 WICKER AVE
SAINT JOHN IN
46373-9052
US

IV. Provider business mailing address

737 WREN CT
GRIFFITH IN
46319-3753
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-7930
  • Fax:
Mailing address:
  • Phone: 219-670-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: