Healthcare Provider Details

I. General information

NPI: 1265876080
Provider Name (Legal Business Name): JACQUELINE KAY GERLOFS MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 FULTON ST E STE 114B
GRAND RAPIDS MI
49503-3200
US

IV. Provider business mailing address

5488 WILSON AVE
HUDSONVILLE MI
49426-1529
US

V. Phone/Fax

Practice location:
  • Phone: 616-208-5032
  • Fax:
Mailing address:
  • Phone: 616-862-0426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: