Healthcare Provider Details

I. General information

NPI: 1477295616
Provider Name (Legal Business Name): MARISSA JEAN YOUNAN CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 BELLE ISLE VIEW BLVD
WINDSOR ONTARIO
N8S3G7
CA

IV. Provider business mailing address

1224 BELLE ISLE VIEW BLVD
WINDSOR ONTARIO
N8S3G7
CA

V. Phone/Fax

Practice location:
  • Phone: 801-931-6189
  • Fax:
Mailing address:
  • Phone:
  • 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: