Healthcare Provider Details

I. General information

NPI: 1750050902
Provider Name (Legal Business Name): KATHRYN ALICE TERESA ELLIOTT MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 GEARY BLVD FL 3
SAN FRANCISCO CA
94115-3300
US

IV. Provider business mailing address

2350 GEARY BLVD FL 3
SAN FRANCISCO CA
94115-3305
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC001464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: