Provider Demographics
NPI:1811693757
Name:BERTON, JACQUELYNN AMANDA (MS CGC)
Entity type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:AMANDA
Last Name:BERTON
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 1:3661 HEEKIN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-4438
Mailing Address - Country:US
Mailing Address - Phone:252-767-1956
Mailing Address - Fax:
Practice Address - Street 1:3661 HEEKIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-4438
Practice Address - Country:US
Practice Address - Phone:252-767-1956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70.000774170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS