MEDICARE: MS. SARAH LOUISE GRIFFIN M.S., C.G.C.

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.)

General Provider Information

NPI Number	:	1376532242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH LOUISE GRIFFIN M.S., C.G.C.

Provider Business Mailing Address
First Line	:	550 OSBORNE RD NE
Second Line	:	INTERNAL ZIP 52790
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-4645
Fax Number	:	763-236-3010

Provider Business Practice Location Address
First Line	:	550 OSBORNE RD NE
Second Line	:	INTERNAL ZIP 52790
City	:	FRIDLEY
State	:	MN
Zip	:	55432-2718
Country	:	US
Telephone Number	:	763-236-4645
Fax Number	:	763-236-3010

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	12/28/2015

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