Provider Demographics
NPI:1225825656
Name:INGERSOLL, MICHAEL CHRISTIAN
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHRISTIAN
Last Name:INGERSOLL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SPADE DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-7934
Mailing Address - Country:US
Mailing Address - Phone:707-673-7479
Mailing Address - Fax:
Practice Address - Street 1:706 SPADE DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-7934
Practice Address - Country:US
Practice Address - Phone:707-673-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician