Provider Demographics
NPI:1679095673
Name:FERNBACH, DEVONN
Entity Type:Individual
Prefix:
First Name:DEVONN
Middle Name:
Last Name:FERNBACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEVONN
Other - Middle Name:
Other - Last Name:TREVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4224
Mailing Address - Country:US
Mailing Address - Phone:989-797-3400
Mailing Address - Fax:989-799-0206
Practice Address - Street 1:SAGINAW COUNTY MENTAL HEALTH
Practice Address - Street 2:500 HANCOCK ST
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4224
Practice Address - Country:US
Practice Address - Phone:989-797-3400
Practice Address - Fax:989-799-0206
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician