Provider Demographics
NPI:1528825387
Name:GERRALD, TAMMI JO (LEP)
Entity type:Individual
Prefix:MS
First Name:TAMMI
Middle Name:JO
Last Name:GERRALD
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 HORIZON CIR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9712
Mailing Address - Country:US
Mailing Address - Phone:530-415-9210
Mailing Address - Fax:
Practice Address - Street 1:11645 RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5024
Practice Address - Country:US
Practice Address - Phone:530-273-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3448103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool