Provider Demographics
NPI:1376604116
Name:HALLIDAY, JACQUELYN VERONICA (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:VERONICA
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:PRC AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:101 PLAIN ST FL 6
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4829
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-453-7622
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC032170300000X
RIGC00001170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS