Provider Demographics
NPI:1649952490
Name:DELLANGELO, JEAN
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:DELLANGELO
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:FREEPORT WEST, F-2
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84016
Mailing Address - Country:US
Mailing Address - Phone:801-402-5403
Mailing Address - Fax:801-402-5401
Practice Address - Street 1:1010 N EMERALD DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-8260
Practice Address - Country:US
Practice Address - Phone:801-916-1348
Practice Address - Fax:801-402-4897
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112581-4102235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist