Provider Demographics
NPI:1871217893
Name:GREENWOOD, JACLYN MARIE (MS, LCGC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 CITY BLVD W STE 800
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-5901
Mailing Address - Country:US
Mailing Address - Phone:714-456-5792
Mailing Address - Fax:714-456-5330
Practice Address - Street 1:333 CITY BLVD W STE 800
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5901
Practice Address - Country:US
Practice Address - Phone:714-456-5792
Practice Address - Fax:714-456-5330
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001548170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS