Provider Demographics
NPI:1811771231
Name:GINGERICH, JACKLYNN M
Entity type:Individual
Prefix:MRS
First Name:JACKLYNN
Middle Name:M
Last Name:GINGERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9760 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14105-9709
Mailing Address - Country:US
Mailing Address - Phone:716-870-4539
Mailing Address - Fax:585-800-1411
Practice Address - Street 1:9760 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLEPORT
Practice Address - State:NY
Practice Address - Zip Code:14105-9709
Practice Address - Country:US
Practice Address - Phone:716-870-4539
Practice Address - Fax:585-800-1411
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker