Provider Demographics
NPI:1356172225
Name:GERRITY, VERONICA CHAMPION
Entity type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:CHAMPION
Last Name:GERRITY
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 1:7342 E PATRICIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-8424
Mailing Address - Country:US
Mailing Address - Phone:913-961-4554
Mailing Address - Fax:
Practice Address - Street 1:813 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-4511
Practice Address - Country:US
Practice Address - Phone:360-890-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61574732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health