Healthcare Provider Details

I. General information

NPI: 1396527552
Provider Name (Legal Business Name): MEGAN GERAK MSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2023
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NW 5TH ST STE 3
GRAND RAPIDS MN
55744-2758
US

IV. Provider business mailing address

502 NE 4TH AVE
GRAND RAPIDS MN
55744-2820
US

V. Phone/Fax

Practice location:
  • Phone: 218-250-8687
  • Fax: 218-203-4782
Mailing address:
  • Phone: 218-250-8687
  • Fax: 218-203-4782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MEGAN AMANDA GERAK
Title or Position: CLINICAL SOCIAL WORKER/THERAPIST
Credential: LICSW
Phone: 218-398-0988