Provider Demographics
NPI:1083926463
Name:CASTONGUAY, CAROLYN (MS, CGC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:CASTONGUAY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:PROCHNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 W OKLAHOMA AVE
Mailing Address - Street 2:GENOMIC MEDICINE PROGRAM
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4330
Mailing Address - Country:US
Mailing Address - Phone:414-649-5639
Mailing Address - Fax:
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:GENOMIC MEDICINE PROGRAM
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS