Provider Demographics
NPI:1205108958
Name:GINGRICH, RENAE LYNN (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:LYNN
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 W 66TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2483
Mailing Address - Country:US
Mailing Address - Phone:605-838-7297
Mailing Address - Fax:
Practice Address - Street 1:706 EAGLE RUN
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-2142
Practice Address - Country:US
Practice Address - Phone:605-428-5851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002017235Z00000X
MN8603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist