Provider Demographics
NPI:1629567102
Name:JELINEK, PETE
Entity Type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name:JELINEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6632 S 191ST PL
Mailing Address - Street 2:SUITE E-103
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6632 S 191ST PL
Practice Address - Street 2:SUITE E-103
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032
Practice Address - Country:US
Practice Address - Phone:425-656-8811
Practice Address - Fax:425-656-9015
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603171347253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care