Provider Demographics
NPI:1851052070
Name:TELLES, JAY MICHAEL (BA-SLPA)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:MICHAEL
Last Name:TELLES
Suffix:
Gender:M
Credentials:BA-SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1638 B ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3020
Mailing Address - Country:US
Mailing Address - Phone:510-639-2929
Mailing Address - Fax:
Practice Address - Street 1:1638 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3020
Practice Address - Country:US
Practice Address - Phone:510-639-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69492355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant