Provider Demographics
NPI:1093442782
Name:HALLECK, JENNIFER ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:HALLECK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MEDICINE CIRCLE MORRIS CLINIC ROOM 25153
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-668-5172
Mailing Address - Fax:919-668-6119
Practice Address - Street 1:30 MEDICINE CIRCLE MORRIS CLINIC ROOM 25153
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-668-5172
Practice Address - Fax:919-668-6119
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS