Provider Demographics
NPI:1093964017
Name:CHALONER, JAE LINDSAY MARIE (MS, LGC)
Entity Type:Individual
Prefix:
First Name:JAE LINDSAY
Middle Name:MARIE
Last Name:CHALONER
Suffix:
Gender:F
Credentials:MS, LGC
Other - Prefix:
Other - First Name:JAE LINDSAY
Other - Middle Name:MARIE
Other - Last Name:DEDMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 W MEMORIAL RD STE 321
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8300
Mailing Address - Country:US
Mailing Address - Phone:405-748-4726
Mailing Address - Fax:405-607-8497
Practice Address - Street 1:4140 W MEMORIAL RD STE 321
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8300
Practice Address - Country:US
Practice Address - Phone:405-748-4726
Practice Address - Fax:405-607-8497
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200212500AMedicaid
OK18OtherLICENSED GENETIC COUNSELOR - OK