Provider Demographics
NPI:1326708595
Name:MOGILEWSKI, JALANA
Entity Type:Individual
Prefix:
First Name:JALANA
Middle Name:
Last Name:MOGILEWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5329 OSAGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1410
Mailing Address - Country:US
Mailing Address - Phone:484-632-4939
Mailing Address - Fax:
Practice Address - Street 1:3580 INDIAN QUEEN LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1540
Practice Address - Country:US
Practice Address - Phone:484-632-4939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist