Provider Demographics
NPI:1225641491
Name:GERITZ, SIERRA JEAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:JEAN
Last Name:GERITZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:DASSEL
Mailing Address - State:MN
Mailing Address - Zip Code:55325-0215
Mailing Address - Country:US
Mailing Address - Phone:320-640-7774
Mailing Address - Fax:
Practice Address - Street 1:201 ATLANTIC AVE W
Practice Address - Street 2:
Practice Address - City:DASSEL
Practice Address - State:MN
Practice Address - Zip Code:55325
Practice Address - Country:US
Practice Address - Phone:320-640-7774
Practice Address - Fax:763-682-2312
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist