Provider Demographics
NPI:1558969477
Name:WESTGERDES, CARYL
Entity Type:Individual
Prefix:
First Name:CARYL
Middle Name:
Last Name:WESTGERDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3064 EAGLE COVE DR
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45167-9683
Mailing Address - Country:US
Mailing Address - Phone:937-392-4581
Mailing Address - Fax:
Practice Address - Street 1:3064 EAGLE COVE DR
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-9683
Practice Address - Country:US
Practice Address - Phone:937-392-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities