Provider Demographics
NPI:1164945366
Name:REVELLE, JANET LEE (AUD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:REVELLE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 ROUTE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-807-0800
Mailing Address - Fax:
Practice Address - Street 1:436 CHRIS GAUPP DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4487
Practice Address - Country:US
Practice Address - Phone:609-748-5370
Practice Address - Fax:609-748-6870
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YA00010900231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist