Provider Demographics
NPI:1124230586
Name:BOEHLECKE, JEANNE GRESKO (MS)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:GRESKO
Last Name:BOEHLECKE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:GRESKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:608 CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2505
Mailing Address - Country:US
Mailing Address - Phone:919-942-7909
Mailing Address - Fax:
Practice Address - Street 1:115 TIMBERHILL PL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1586
Practice Address - Country:US
Practice Address - Phone:919-967-5959
Practice Address - Fax:919-968-1478
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional