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NPI Code Detail

MEDICARE: GWENDOLYN STEFFEN CONNOR MS, CGC

MEDICARE:   GWENDOLYN STEFFEN CONNOR  MS, CGC
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
1170300000XGenetic Counselor (M.S.)

General Provider Information

NPI Number : 1336164441
Entity Type Code : Individual
Provider Name (Legal Business Name) : GWENDOLYN STEFFEN CONNOR MS, CGC
Provider Business Mailing Address
First Line : 9408 OLIPHANT AVE
Second Line :
City : MORTON GROVE
State : IL
Zip : 60053-1048
Country : US
Telephone Number : 312-607-6935
Fax Number :
Provider Business Practice Location Address
First Line : 250 E SUPERIOR ST RM 5-2221
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2914
Country : US
Telephone Number : 312-472-4153
Fax Number : 312-472-4564
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 02/05/2016

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