1821087495 NPI number — KAREN LEIGH WCISLO M.S., CGC

Table of content: KAREN LEIGH WCISLO M.S., CGC (NPI 1821087495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821087495 NPI number — KAREN LEIGH WCISLO M.S., CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WCISLO
Provider First Name:
KAREN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821087495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GENETICS DEPARTMENT, KAISER PERMANENTE
Provider Second Line Business Mailing Address:
5755 COTTLE ROAD, BUILDING 1
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-972-3306
Provider Business Mailing Address Fax Number:
408-972-3298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GENETICS DEPARTMENT, KAISER PERMANENTE
Provider Second Line Business Practice Location Address:
5755 COTTLE ROAD, BUILDING 1
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-972-3306
Provider Business Practice Location Address Fax Number:
408-972-3298
Provider Enumeration Date:
10/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)