Provider Demographics
NPI:1477058287
Name:GERARD ACADEMY
Entity Type:Organization
Organization Name:GERARD ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:507-433-1843
Mailing Address - Street 1:1101 28TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912
Mailing Address - Country:US
Mailing Address - Phone:507-433-1843
Mailing Address - Fax:507-433-7868
Practice Address - Street 1:1101 28TH ST NE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-433-1843
Practice Address - Fax:507-433-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty