Provider Demographics
NPI:1689305237
Name:WHITCOMB, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WHITCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TESS
Other - Middle Name:
Other - Last Name:WHITCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:975 W WALNUT ST # IB-167
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5181
Mailing Address - Country:US
Mailing Address - Phone:317-944-0060
Mailing Address - Fax:
Practice Address - Street 1:975 W WALNUT ST # IB-167
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5181
Practice Address - Country:US
Practice Address - Phone:317-944-0060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
IN99112426A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS