Provider Demographics
NPI:1346702420
Name:HUSSONG, DEVIN KENNY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:KENNY
Last Name:HUSSONG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-1804
Mailing Address - Country:US
Mailing Address - Phone:908-902-0069
Mailing Address - Fax:
Practice Address - Street 1:2132 S 12TH ST STE 103
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4814
Practice Address - Country:US
Practice Address - Phone:484-350-3447
Practice Address - Fax:484-221-8193
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty