Provider Demographics
NPI:1861852675
Name:HACKBARDT, MICHELLE (CGC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HACKBARDT
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 WOODLAND VALLEY GLN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3836
Mailing Address - Country:US
Mailing Address - Phone:760-522-5681
Mailing Address - Fax:714-456-5330
Practice Address - Street 1:1975 WOODLAND VALLEY GLN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3836
Practice Address - Country:US
Practice Address - Phone:760-522-5681
Practice Address - Fax:714-456-5330
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000798170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS