Individual
MISS MADISON JESSE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1701 SW 16TH AVE BLDG B, GAINESVILLE, FL 32608-1153
(352) 294-5050
(352) 294-8058
Mailing address
PO BOX 100296, GAINESVILLE, FL 32610-0296
(352) 294-5050
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
—
—
Other
Enumeration date
08/15/2022
Last updated
08/15/2022
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