Individual
MS. KERRY KINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
875 BLAKE WILBUR DR RM 2320, STANFORD CANCER CENTER, PALO ALTO, CA 94304-2205
(650) 724-6702
(650) 498-5150
Mailing address
875 BLAKE WILBUR DRIVE, #2320, STANFORD, CA 94305
(650) 724-6702
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GC000252
GENETIC COUNSELOR LICENSE NUMBER
CA
Enumeration date
12/15/2006
Last updated
11/29/2012
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