Healthcare Provider Details

I. General information

NPI: 1679407654
Provider Name (Legal Business Name): JAMIE GHERE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3294 WILLOW CREEK RD
COLGATE WI
53017-9534
US

IV. Provider business mailing address

N104W13840 DONGES BAY RD
GERMANTOWN WI
53022-4430
US

V. Phone/Fax

Practice location:
  • Phone: 262-502-7281
  • Fax:
Mailing address:
  • Phone: 262-502-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number693021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: