Provider Demographics
NPI:1700321817
Name:NESLADEK, JOETTE
Entity type:Individual
Prefix:
First Name:JOETTE
Middle Name:
Last Name:NESLADEK
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 1:201 S BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:PRESHO
Mailing Address - State:SD
Mailing Address - Zip Code:57568-5311
Mailing Address - Country:US
Mailing Address - Phone:605-895-2579
Mailing Address - Fax:
Practice Address - Street 1:411 E. 2ND STREET
Practice Address - Street 2:
Practice Address - City:KENNEBEC
Practice Address - State:SD
Practice Address - Zip Code:57544
Practice Address - Country:US
Practice Address - Phone:605-869-8813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD692-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist