Healthcare Provider Details

I. General information

NPI: 1477481273
Provider Name (Legal Business Name): KATIE JEAN GAJESKI M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 AMY ST
GREEN BAY WI
54302-3146
US

IV. Provider business mailing address

1770 AMY ST
GREEN BAY WI
54302-3146
US

V. Phone/Fax

Practice location:
  • Phone: 920-518-3759
  • Fax:
Mailing address:
  • Phone: 920-518-3759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: