Provider Demographics
NPI:1730465048
Name:DE GELLEKE, JANE MARY (SP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:MARY
Last Name:DE GELLEKE
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 ROYAL OAKS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-3868
Mailing Address - Country:US
Mailing Address - Phone:916-923-1789
Mailing Address - Fax:916-923-1515
Practice Address - Street 1:1901 ROYAL OAKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-3868
Practice Address - Country:US
Practice Address - Phone:916-923-1789
Practice Address - Fax:916-923-1515
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist