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General NPI Number Information
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NPI Number | 1205119575
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Entity Type | Individual
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Provider Name | JESSICA K. PACK MHA, MS, LGC
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Gender | Female
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Dates
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Enumeration Date | 09/23/2011
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 4330 GLENVIEW AVENUE #111
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City | GLENVIEW
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State | KY
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Zip | 40025-0111
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Country | US
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Telephone | 888-252-2842
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Fax | 502-470-3645
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Provider Business Mailing Address
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Address Line | PO BOX 3139
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City | CORYDON
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State | IN
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Zip | 47112-3139
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Country | US
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Telephone | 888-252-2842
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Fax | 502-470-3645
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170300000X
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Taxonomy Name | Genetic Counselor (M.S.)
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License Number |
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License Number State |
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