Provider Demographics
NPI:1275304818
Name:GERSON, SHERI MILA (PHD)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:MILA
Last Name:GERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 ORCHARD DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4269
Mailing Address - Country:US
Mailing Address - Phone:360-789-0738
Mailing Address - Fax:
Practice Address - Street 1:1962 ORCHARD DR NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4269
Practice Address - Country:US
Practice Address - Phone:360-789-0738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL77131041C0700X
WALW000065541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical