Provider Demographics
NPI:1760024681
Name:TSIKERDANOS, COLLEEN WOLF-FISHER (CGC)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:WOLF-FISHER
Last Name:TSIKERDANOS
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:WOLF
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9902 MAIDBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1240
Mailing Address - Country:US
Mailing Address - Phone:410-610-0980
Mailing Address - Fax:
Practice Address - Street 1:9902 MAIDBROOK RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-1240
Practice Address - Country:US
Practice Address - Phone:410-610-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-11
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC001221OtherGENETIC COUNSELING LICENSE
NMGC2019-014OtherGENETIC COUNSELING LICENSE
KYGC202OtherGENETIC COUNSELING LICENSE