Provider Demographics
NPI:1710288576
Name:PICKARSKI, JUSTINE COOPER (MS, CGC)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:COOPER
Last Name:PICKARSKI
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:M
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-323-3083
Mailing Address - Fax:859-323-4667
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-323-3083
Practice Address - Fax:859-323-4667
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
KYGC011170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS