Provider Demographics
NPI:1508553470
Name:GENOCH, CHERYL A (LADC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:GENOCH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1571
Mailing Address - Country:US
Mailing Address - Phone:218-631-7605
Mailing Address - Fax:218-631-7616
Practice Address - Street 1:124 1ST ST SE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1571
Practice Address - Country:US
Practice Address - Phone:218-631-7605
Practice Address - Fax:218-631-7616
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)