Healthcare Provider Details

I. General information

NPI: 1306407051
Provider Name (Legal Business Name): ZOE GELLIS DUENSING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 04/04/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 J ST # 210
SACRAMENTO CA
95816-4711
US

IV. Provider business mailing address

2115 J ST SACRAMENTO, CA #210
SACRAMENTO CA
95816-4927
US

V. Phone/Fax

Practice location:
  • Phone: 916-444-0033
  • Fax:
Mailing address:
  • Phone: 916-444-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: