Provider Demographics
NPI:1619175973
Name:JELTEMA, JANA MICHELE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:MICHELE
Last Name:JELTEMA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6757 OLEANDER WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-3329
Mailing Address - Country:US
Mailing Address - Phone:760-877-1512
Mailing Address - Fax:
Practice Address - Street 1:6757 OLEANDER WAY
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3329
Practice Address - Country:US
Practice Address - Phone:760-877-1512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0004010235Z00000X
CA19737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412721Medicaid