Provider Demographics
NPI:1396298964
Name:CHICAGO GENETIC CONSULTANTS, LLC
Entity type:Organization
Organization Name:CHICAGO GENETIC CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENETIC COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CGC
Authorized Official - Phone:888-725-4363
Mailing Address - Street 1:801 SKOKIE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4039
Mailing Address - Country:US
Mailing Address - Phone:888-725-4363
Mailing Address - Fax:
Practice Address - Street 1:801 SKOKIE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4039
Practice Address - Country:US
Practice Address - Phone:888-725-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246.000009170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170300000XOther Service ProvidersGenetic Counselor, MSGroup - Single Specialty