Provider Demographics
NPI:1417631045
Name:HUMANSKI, JESSICA MEGAN (MS, CGC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEGAN
Last Name:HUMANSKI
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JESSA
Other - Middle Name:
Other - Last Name:HUMANSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:1497 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3602
Mailing Address - Country:US
Mailing Address - Phone:847-975-0803
Mailing Address - Fax:
Practice Address - Street 1:320 S WAKARA WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1214
Practice Address - Country:US
Practice Address - Phone:800-469-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS