MEDICARE: DR. KARLA JANE GINGERICH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	2453	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699743179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARLA JANE GINGERICH PH.D.

Provider Business Mailing Address
First Line	:	2750 SAGE CREEK RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3107
Country	:	US
Telephone Number	:	970-491-3937
Fax Number	:	970-491-1032

Provider Business Practice Location Address
First Line	:	3351 EASTBROOK DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-5744
Country	:	US
Telephone Number	:	970-491-3937
Fax Number	:	970-491-1032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/08/2007

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