MEDICARE: MS. ALEXANDRIA CORREALE-OTTO 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.)

General Provider Information

NPI Number	:	1912649823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXANDRIA CORREALE-OTTO CGC

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-454-6093
Fax Number	:	844-965-9624

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PL
Second Line	:	DIV PED GENETICS AND GENOMIC MED
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-6093
Fax Number	:	844-965-9624

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

Provider Enumeration Date	:	04/11/2022
Last Update Date	:	05/18/2026

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