Provider Demographics
NPI:1407939648
Name:MACGREGOR, JO ANN (PHD)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:MACGREGOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 PROLINE PL
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-9400
Mailing Address - Country:US
Mailing Address - Phone:717-337-3005
Mailing Address - Fax:717-337-3301
Practice Address - Street 1:1400 PROLINE PL
Practice Address - Street 2:SUITE 1000
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-9400
Practice Address - Country:US
Practice Address - Phone:717-337-3005
Practice Address - Fax:717-337-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS009225L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001859211Medicaid
PA001859211Medicaid