Provider Demographics
NPI:1508220807
Name:WAKELING, ADRIENNE MILLER (MS)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MILLER
Last Name:WAKELING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 DIVISADERO STREET
Mailing Address - Street 2:BOX 1714
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-3010
Mailing Address - Country:US
Mailing Address - Phone:415-514-6644
Mailing Address - Fax:415-885-3787
Practice Address - Street 1:1600 DIVISADERO STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-3010
Practice Address - Country:US
Practice Address - Phone:415-514-6644
Practice Address - Fax:415-885-3787
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC00048170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS