Provider Demographics
NPI:1467998112
Name:FIALA, ELISE MARGUERITE (CGC)
Entity Type:Individual
Prefix:MS
First Name:ELISE
Middle Name:MARGUERITE
Last Name:FIALA
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PL
Mailing Address - Street 2:NWT 1230
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-6093
Mailing Address - Fax:314-454-2075
Practice Address - Street 1:1 CHILDRENS PL STE C
Practice Address - Street 2:STE C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6093
Practice Address - Fax:314-454-2075
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS