Healthcare Provider Details

I. General information

NPI: 1154928117
Provider Name (Legal Business Name): JORDAN GERICKE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JORDAN COMBS

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT STE 210
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

5377 HIGHWAY N STE 541
SAINT CHARLES MO
63304-8032
US

V. Phone/Fax

Practice location:
  • Phone: 636-486-6965
  • Fax:
Mailing address:
  • Phone: 636-486-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: