Provider Demographics
NPI:1235532904
Name:WAKEFIELD, EMILY GILES (LGC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GILES
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LGC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 7016
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-803-5441
Mailing Address - Fax:513-636-4373
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 7016
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-803-5441
Practice Address - Fax:513-636-4373
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70.000143170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS