Provider Demographics
NPI:1558616425
Name:GERLACH, JEREMY T
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:T
Last Name:GERLACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-5068
Mailing Address - Country:US
Mailing Address - Phone:563-241-4230
Mailing Address - Fax:563-519-4235
Practice Address - Street 1:1377 11TH ST NW
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5068
Practice Address - Country:US
Practice Address - Phone:563-241-4230
Practice Address - Fax:563-519-4235
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist