Provider Demographics
NPI:1548840077
Name:GINGRICH, DEVON MCKAIN (PSYD)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:MCKAIN
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-4014
Mailing Address - Country:US
Mailing Address - Phone:717-222-1546
Mailing Address - Fax:833-903-1465
Practice Address - Street 1:44 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNVILLE
Practice Address - State:PA
Practice Address - Zip Code:17003-1411
Practice Address - Country:US
Practice Address - Phone:717-966-1388
Practice Address - Fax:833-903-1465
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical