Healthcare Provider Details
I. General information
NPI: 1972232817
Provider Name (Legal Business Name): MADELINE DELORIA MS, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 06/07/2022
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
704 CUMBERLAND RD # 2
AUSTIN TX
78704-6242
US
IV. Provider business mailing address
704 CUMBERLAND RD # 2
AUSTIN TX
78704-6242
US
V. Phone/Fax
- Phone: 415-305-9454
- Fax:
- Phone: 415-305-9454
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 25MJ00053600 |
| License Number State | NJ |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 0292 |
| License Number State | SD |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 12072723-3601 |
| License Number State | UT |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 94 |
| License Number State | AL |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 266 |
| License Number State | NE |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 0240 |
| License Number State | ND |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | GC000721 |
| License Number State | PA |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | GT61073601 |
| License Number State | WA |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | GEN-255 |
| License Number State | ID |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | LCG-0163 |
| License Number State | AR |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 1411 |
| License Number State | MN |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 363 |
| License Number State | CT |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 0414 |
| License Number State | OK |
| # 14 | |
| Primary Taxonomy | N |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | 325656 |
| License Number State | LA |
| # 15 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 170300000X |
| Taxonomy | Genetic Counselor (M.S.) |
| License Number | GC001189 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
