Healthcare Provider Details

I. General information

NPI: 1427046358
Provider Name (Legal Business Name): CAROLEE W. NOONAN LGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 FRONTENAC PL
WORTHINGTON OH
43085-3817
US

IV. Provider business mailing address

3333 BURNET AVE MLC 4006
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 614-306-9898
  • Fax:
Mailing address:
  • Phone: 513-636-4760
  • Fax: 513-636-7297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number70.000021
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: