Provider Demographics
NPI:1992095368
Name:FONG, JAMIE CAROLINE (MS, CGC)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:CAROLINE
Last Name:FONG
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 1:350 PARNASSUS AVE. SUITE 905
Mailing Address - Street 2:UCSF MEMORY AND AGING CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-476-8613
Mailing Address - Fax:415-476-4800
Practice Address - Street 1:350 PARNASSUS AVE STE 905
Practice Address - Street 2:UCSF MEMORY AND AGING CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3611
Practice Address - Country:US
Practice Address - Phone:415-476-8613
Practice Address - Fax:415-476-4800
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS