Provider Demographics
NPI:1578453957
Name:GERAETS, AMANDA JEAN (RDH,COM)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JEAN
Last Name:GERAETS
Suffix:
Gender:F
Credentials:RDH,COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 W TOMBSTONE ST
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8199
Mailing Address - Country:US
Mailing Address - Phone:208-968-4271
Mailing Address - Fax:
Practice Address - Street 1:6636 W TOMBSTONE ST
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-8199
Practice Address - Country:US
Practice Address - Phone:208-968-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IDDH-4488124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No124Q00000XDental ProvidersDental Hygienist