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General NPI Number Information
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NPI Number | 1396298964
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Entity Type | Organization
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Legal Business Name | CHICAGO GENETIC CONSULTANTS, LLC
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 801 SKOKIE BLVD SUITE 110
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City | NORTHBROOK
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State | IL
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Zip | 60062-4039
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Country | US
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Telephone | 888-725-4363
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Fax |
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Provider Business Mailing Address
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Address Line | 801 SKOKIE BLVD SUITE 110
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City | NORTHBROOK
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State | IL
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Zip | 60062-4039
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Country | US
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Telephone | 888-725-4363
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Fax |
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Authorized Official
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Title or Position | GENETIC COUNSELOR
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Name | MR. SCOTT M WEISSMAN
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Credential | MS, CGC
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Telephone | 888-725-4363
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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 | 246.000009
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License Number State | IL
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