Provider Demographics
NPI:1023155629
Name:BILECKI, MARYANN (MA)
Entity type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:BILECKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 SUMMERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-7815
Mailing Address - Country:US
Mailing Address - Phone:707-523-7025
Mailing Address - Fax:707-523-3024
Practice Address - Street 1:2451 SUMMERFIELD RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-7815
Practice Address - Country:US
Practice Address - Phone:707-523-7025
Practice Address - Fax:707-523-3024
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU877231HA2500X
CAHA3463237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACPG164426Medicaid