Healthcare Provider Details

I. General information

NPI: 1457860587
Provider Name (Legal Business Name): JACQUELINE LOUISE GELETA MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD
BAY PINES FL
33744-8200
US

IV. Provider business mailing address

235 3RD AVE N UNIT 312
ST PETERSBURG FL
33701-3376
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 727-398-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA15445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: