Healthcare Provider Details

I. General information

NPI: 1215558762
Provider Name (Legal Business Name): ALLISON GOSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 JEFFERSON PARK AVE
CHARLOTTESVILLE VA
22903-3363
US

IV. Provider business mailing address

1061 COMPTON PL
FOREST VA
24551-2677
US

V. Phone/Fax

Practice location:
  • Phone: 434-382-8328
  • Fax:
Mailing address:
  • Phone: 434-382-8328
  • 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: