Provider Demographics
NPI:1649350109
Name:FONDA ALLEN, JILL SUZANNE (MS)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:FONDA ALLEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:SUZANNE
Other - Last Name:FONDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:21310 RIDGECROFT DR
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-1818
Mailing Address - Country:US
Mailing Address - Phone:301-260-0096
Mailing Address - Fax:
Practice Address - Street 1:21310 RIDGECROFT DR
Practice Address - Street 2:
Practice Address - City:BROOKEVILLE
Practice Address - State:MD
Practice Address - Zip Code:20833-1818
Practice Address - Country:US
Practice Address - Phone:301-260-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS