Provider Demographics
NPI:1770839078
Name:DEPAS, MORGAN M (GC)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:M
Last Name:DEPAS
Suffix:
Gender:F
Credentials:GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:GENETIC COUNSELING OFFICE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-5899
Mailing Address - Fax:414-955-6516
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:GENETIC COUNSELING OFFICE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-5899
Practice Address - Fax:414-955-6516
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000030170300000X
WI170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
15444OtherABGC - AMERICAN BOARD OF GENETIC COUNSELING
TNGC0000000030OtherTN STATE LICENSE