Provider Demographics
NPI:1881060226
Name:GERRY, ANDREA KATHLEEN
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KATHLEEN
Last Name:GERRY
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 1:4812 W 159TH TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9392
Mailing Address - Country:US
Mailing Address - Phone:913-209-3897
Mailing Address - Fax:
Practice Address - Street 1:8400 W 110TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2331
Practice Address - Country:US
Practice Address - Phone:913-327-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2682106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist