Provider Demographics
NPI:1669075834
Name:GIEGENGACK, JENNIFER BEVILACQUA (MS, CGC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BEVILACQUA
Last Name:GIEGENGACK
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:BEVILACQUA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CGC
Mailing Address - Street 1:98 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7809
Mailing Address - Country:US
Mailing Address - Phone:203-623-5857
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2870
Practice Address - Country:US
Practice Address - Phone:203-384-4705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTGC.000010170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS