Healthcare Provider Details

I. General information

NPI: 1174950737
Provider Name (Legal Business Name): ILANA CHILTON MS CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY # 7N-718
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

14737 MAPLE ST
OVERLAND PARK KS
66223-1217
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6526
  • Fax:
Mailing address:
  • Phone: 913-269-0069
  • Fax:

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: