Provider Demographics
NPI:1811268758
Name:GERSHATER, JENNIE J (LMT, MA)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:J
Last Name:GERSHATER
Suffix:
Gender:F
Credentials:LMT, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5026
Mailing Address - Country:US
Mailing Address - Phone:303-827-4278
Mailing Address - Fax:
Practice Address - Street 1:1910 7TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5026
Practice Address - Country:US
Practice Address - Phone:303-827-4278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0010912101YM0800X
374J00000X, 174400000X, 172V00000X
CO0004656225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374J00000XNursing Service Related ProvidersDoula
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172V00000XOther Service ProvidersCommunity Health Worker