Healthcare Provider Details

I. General information

NPI: 1720594229
Provider Name (Legal Business Name): CORRINE FILLMAN MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 CETRONIA RD STE 225S
ALLENTOWN PA
18104-9701
US

IV. Provider business mailing address

106 HARRISON ST
EMMAUS PA
18049-2606
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-4160
  • Fax: 833-616-6610
Mailing address:
  • Phone: 610-628-7039
  • Fax: 201-605-6582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number000205
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number25MJ00017700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246.000236
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000677
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGC000101
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: