Individual
JENNIFER JANE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GC
Contact information
Practice address
7120 CLEARVISTA DR STE 5900, INDIANAPOLIS, IN 46256-1714
(317) 621-5395
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-1647
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
74000181A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300008014
—
IN
01
—
74000181A
INDIANA GENETIC COUNSELOR LICENSE
IN
01
—
K02-66-8390
DRIVERS LICENSE
KS
Enumeration date
05/23/2017
Last updated
06/04/2021
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