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General NPI Number Information
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NPI Number | 1972371821
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Entity Type | Individual
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Provider Name | JACOB MICHAEL GEREND
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Gender | Male
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Dates
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Enumeration Date | 12/19/2023
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Last Update Date | 12/19/2023
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Provider Practice Location Address
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Address Line | 7525 VILLAGE DR STE 130
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City | LINO LAKES
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State | MN
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Zip | 55014-1305
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Country | US
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Telephone | 612-889-9707
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Fax |
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Provider Business Mailing Address
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Address Line | 2159 DELAWARE AVE
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55118-4803
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Country | US
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Telephone | 612-889-9707
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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