MEDICARE: EDEN JESSICA KROIN MGCS, GC

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.)
2	170300000X	Genetic Counselor (M.S.)	246-000474	IL

General Provider Information

NPI Number	:	1275014250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDEN JESSICA KROIN MGCS, GC

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1875 DEMPSTER ST STE 285
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1157
Country	:	US
Telephone Number	:	847-723-7705
Fax Number	:

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

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	12/06/2024

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