Healthcare Provider Details

I. General information

NPI: 1205066107
Provider Name (Legal Business Name): MARY K DELANY-HUDZIK CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2009
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 JOLLYVILLE RD SUITE 200
AUSTIN TX
78759-5593
US

IV. Provider business mailing address

621 BEVERLY DR
MAGNOLIA NJ
08049-1649
US

V. Phone/Fax

Practice location:
  • Phone: 608-692-2818
  • Fax:
Mailing address:
  • Phone: 856-258-2446
  • 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: