Provider Demographics
NPI:1295596443
Name:OCAMPO, GERARDO (BT2)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:OCAMPO
Suffix:
Gender:M
Credentials:BT2
Other - Prefix:
Other - First Name:GERARDO
Other - Middle Name:
Other - Last Name:JARA OCAMPO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9201 OLD CEDAR AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-2401
Mailing Address - Country:US
Mailing Address - Phone:952-854-1800
Mailing Address - Fax:
Practice Address - Street 1:9201 OLD CEDAR AVE S
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-2401
Practice Address - Country:US
Practice Address - Phone:952-854-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician