Healthcare Provider Details

I. General information

NPI: 1366757684
Provider Name (Legal Business Name): STACY WOYCIECHOWSKI MS CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 CIVIC CENTER BLVD ARC RM. 703E
PHILADELPHIA PA
19104-4318
US

IV. Provider business mailing address

3615 CIVIC CENTER BLVD ARC RM. 703E
PHILADELPHIA PA
19104-4318
US

V. Phone/Fax

Practice location:
  • Phone: 267-426-7484
  • Fax: 215-590-5454
Mailing address:
  • Phone: 267-426-7484
  • Fax: 215-590-5454

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: