Provider Demographics
NPI:1356685846
Name:TIRCH, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:TIRCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 WILLOW RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1544
Mailing Address - Country:US
Mailing Address - Phone:650-752-1318
Mailing Address - Fax:
Practice Address - Street 1:1350 WILLOW RD STE 202
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1544
Practice Address - Country:US
Practice Address - Phone:650-752-1318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000532170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS