Provider Demographics
NPI:1083671655
Name:GINGRICH, GAYLE ANDERSON (LCSW)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:ANDERSON
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 OTIS AVE
Mailing Address - Street 2:SUITE 220A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-1077
Mailing Address - Country:US
Mailing Address - Phone:317-377-1600
Mailing Address - Fax:317-377-1900
Practice Address - Street 1:8902 OTIS AVE
Practice Address - Street 2:SUITE 220A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1077
Practice Address - Country:US
Practice Address - Phone:317-377-1600
Practice Address - Fax:317-377-1900
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005616A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100270530AMedicaid
IN100270530AMedicaid