Healthcare Provider Details

I. General information

NPI: 1285618694
Provider Name (Legal Business Name): ELLEN J THOMAS MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDUSTRIAL RD SUITE 410
SAN CARLOS CA
94070-2396
US

IV. Provider business mailing address

4102 AMY COURT
SPRINGFIELD IL
62711
US

V. Phone/Fax

Practice location:
  • Phone: 650-249-9091
  • Fax: 650-730-2276
Mailing address:
  • Phone: 650-249-9091
  • Fax: 650-730-2276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: