Provider Demographics
NPI:1578180139
Name:GERKE, ADELE M
Entity Type:Individual
Prefix:
First Name:ADELE
Middle Name:M
Last Name:GERKE
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 1:5204 MAHONING AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1808
Mailing Address - Country:US
Mailing Address - Phone:330-797-0036
Mailing Address - Fax:
Practice Address - Street 1:5204 MAHONING AVE STE 105
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-1808
Practice Address - Country:US
Practice Address - Phone:330-797-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker