MEDICARE: JORDANA WEISS LCGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)	0139000754	VA

General Provider Information

NPI Number	:	1134071202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDANA WEISS LCGC

Provider Business Mailing Address
First Line	:	6251 E VIRGINIA BEACH BLVD STE 300
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6251 E VIRGINIA BEACH BLVD STE 300
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23502-2800
Country	:	US
Telephone Number	:	757-261-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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