Provider Demographics
NPI:1609628775
Name:GERLACH, SUZANNE REBECCA (BS PSYCH)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:REBECCA
Last Name:GERLACH
Suffix:
Gender:F
Credentials:BS PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 E MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-7278
Mailing Address - Country:US
Mailing Address - Phone:208-900-8240
Mailing Address - Fax:
Practice Address - Street 1:6205 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3020
Practice Address - Country:US
Practice Address - Phone:208-900-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator