Basic Information
| Provider Information | |||||||||
| NPI: | 1962964684 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENKE | ||||||||
| FirstName: | CHELSEA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | GC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776347 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022725754 | ||||||||
| FaxNumber: | 5022725339 | ||||||||
| Practice Location | |||||||||
| Address1: | 3991 DUTCHMANS LN STE 405 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028993366 | ||||||||
| FaxNumber: | 5026296217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2019 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 170300000X | TGC011 | KY | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.