Healthcare Provider Details

I. General information

NPI: 1962964684
Provider Name (Legal Business Name): CHELSEA ANN MENKE GC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506A MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

IV. Provider business mailing address

10506A MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-5578
  • Fax:
Mailing address:
  • Phone: 513-865-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number74000374A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number70.000773
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: