MEDICARE: ALLYSON DERTING MS, CGC

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.)	246011189	IL

General Provider Information

NPI Number	:	1902766561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON DERTING MS, CGC

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-3496
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST STE 209A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5190
Country	:	US
Telephone Number	:	773-296-7660
Fax Number	:	773-296-7666

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

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	01/22/2026

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