MEDICARE: JAE LINDSAY MARIE CHALONER MS, LGC

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	170300000X	Genetic Counselor (M.S.)	18	OK

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
2	18	OTHER	OK	LICENSED GENETIC COUNSELOR - OK

General Provider Information

NPI Number	:	1093964017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE LINDSAY MARIE CHALONER MS, LGC

Provider Business Mailing Address
First Line	:	4140 W MEMORIAL RD STE 321
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8300
Country	:	US
Telephone Number	:	405-748-4726
Fax Number	:	405-607-8497

Provider Business Practice Location Address
First Line	:	4140 W MEMORIAL RD STE 321
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8300
Country	:	US
Telephone Number	:	405-748-4726
Fax Number	:	405-607-8497

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

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	01/10/2020

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