Individual
MS. THERESA ANN BOOMER
Active
Individual
MS. THERESA ANN BOOMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
246.000083
IL
170300000X
Genetic Counselor (M.S.)
GC0000000027
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2002038
AMERICAN BOARD OF GENETIC COUNELING CERTIFICATION
MT
01
—
246.000083
LICENSED GENETIC COUNSELOR
IL
01
—
GC0000000027
LICENSED GENETIC COUNSELOR
TN
Enumeration date
10/19/2011
Last updated
10/19/2011
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