Provider Demographics
NPI:1235507666
Name:GERLACH, AMY (MS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:GERLACH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4638 VICTOR PATH NORTH
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038
Mailing Address - Country:US
Mailing Address - Phone:651-364-3839
Mailing Address - Fax:651-364-3840
Practice Address - Street 1:4638 VICTOR PATH NORTH
Practice Address - Street 2:SUITE 900
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038
Practice Address - Country:US
Practice Address - Phone:651-364-3839
Practice Address - Fax:651-364-3840
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1942101YP2500X
390200000X
MNCC03632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program