Provider Demographics
NPI:1093591661
Name:GERHARDT, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:MORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1615 E CAPITOL WAY
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2218
Mailing Address - Country:US
Mailing Address - Phone:701-204-7870
Mailing Address - Fax:
Practice Address - Street 1:1615 E CAPITOL WAY
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2218
Practice Address - Country:US
Practice Address - Phone:701-204-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician