Provider Demographics
NPI:1689974818
Name:GALES, JACQUELINE LEE
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LEE
Last Name:GALES
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 1:3833 POCASSET ST
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70805-5648
Mailing Address - Country:US
Mailing Address - Phone:225-975-1573
Mailing Address - Fax:
Practice Address - Street 1:2036 WOODDALE BLVD
Practice Address - Street 2:M
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1518
Practice Address - Country:US
Practice Address - Phone:225-975-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant