Individual
JESSICA K. PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHA, MS, LGC
Contact information
Practice address
4330 GLENVIEW AVENUE, #111, GLENVIEW, KY 40025-0111
(888) 252-2842
(502) 470-3645
Mailing address
PO BOX 3139, CORYDON, IN 47112-3139
(888) 252-2842
(502) 470-3645
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74000172A
GENETIC COUNSELING LICENSE
IN
01
—
96
GENETIC COUNSELING LICENSE
NE
Enumeration date
09/23/2011
Last updated
04/24/2018
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