Healthcare Provider Details

I. General information

NPI: 1023155629
Provider Name (Legal Business Name): MARYANN BILECKI M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 SUMMERFIELD RD
SANTA ROSA CA
95405-7815
US

IV. Provider business mailing address

2451 SUMMERFIELD RD
SANTA ROSA CA
95405-7815
US

V. Phone/Fax

Practice location:
  • Phone: 707-523-7025
  • Fax: 707-523-3024
Mailing address:
  • Phone: 707-523-7025
  • Fax: 707-523-3024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAU877
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHA3463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: