Healthcare Provider Details

I. General information

NPI: 1699580266
Provider Name (Legal Business Name): JACQUELYN GELARDI-HONGACH BS, CADC-DP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 COLUMBIA AVE W
BATTLE CREEK MI
49015-2848
US

IV. Provider business mailing address

2150 COLUMBIA AVE W
BATTLE CREEK MI
49015-2848
US

V. Phone/Fax

Practice location:
  • Phone: 269-364-0663
  • Fax:
Mailing address:
  • Phone: 269-364-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-DP
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: