Provider Demographics
NPI:1265216493
Name:GERAETS, JUSTIN JOSEPH (SLP-CF)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOSEPH
Last Name:GERAETS
Suffix:
Gender:M
Credentials:SLP-CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47172 243RD ST
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-6225
Mailing Address - Country:US
Mailing Address - Phone:605-359-0194
Mailing Address - Fax:
Practice Address - Street 1:1510 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1557
Practice Address - Country:US
Practice Address - Phone:605-367-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1180-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist