Provider Demographics
NPI:1962866970
Name:SCHMIDLEN, TARA JO (MS CGC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JO
Last Name:SCHMIDLEN
Suffix:
Gender:F
Credentials:MS CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-2070
Practice Address - Country:US
Practice Address - Phone:570-214-7941
Practice Address - Fax:570-271-5886
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MJ00008800170300000X
PAGC000265170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS