Provider Demographics
NPI:1861533788
Name:JELETIC, KIMBERLY A (MA,CCC-A)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:JELETIC
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 SALTSBURG RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-2252
Mailing Address - Country:US
Mailing Address - Phone:412-795-1170
Mailing Address - Fax:412-795-1154
Practice Address - Street 1:7125 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-2252
Practice Address - Country:US
Practice Address - Phone:412-795-1170
Practice Address - Fax:412-795-1154
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001022L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist