Provider Demographics
NPI:1992828016
Name:KERN, GERALD A (MA PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:KERN
Suffix:
Gender:M
Credentials:MA PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21850 TERRITORIAL RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9593
Mailing Address - Country:US
Mailing Address - Phone:763-428-4902
Mailing Address - Fax:763-428-4902
Practice Address - Street 1:21850 TERRITORIAL RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9593
Practice Address - Country:US
Practice Address - Phone:763-428-4902
Practice Address - Fax:763-428-4902
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2470103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling