Provider Demographics
NPI:1831486729
Name:DEFEE, JANE B
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:B
Last Name:DEFEE
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 1:2121B BELLEVUE RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2952
Mailing Address - Country:US
Mailing Address - Phone:478-275-6545
Mailing Address - Fax:478-275-6575
Practice Address - Street 1:2121B BELLEVUE RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2952
Practice Address - Country:US
Practice Address - Phone:478-275-6545
Practice Address - Fax:478-275-6575
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003732235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000727955BMedicaid