Provider Demographics
NPI:1285899641
Name:TRAVASSOS, HEATHER S (MS, CGC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:TRAVASSOS
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BUCKWALTER PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-5150
Mailing Address - Country:US
Mailing Address - Phone:800-918-8924
Mailing Address - Fax:
Practice Address - Street 1:400 BUCKWALTER PLACE BLVD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-5150
Practice Address - Country:US
Practice Address - Phone:800-918-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC113170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS