Individual
MR. MICHAEL JEDLICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
532 N MAIN AVE, GRESHAM, OR 97030-7244
(503) 666-1333
(503) 666-2444
Mailing address
532 N MAIN AVE, GRESHAM, OR 97030-7244
(503) 666-1333
(503) 666-2444
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12708
OR
Other
Enumeration date
02/21/2011
Last updated
02/21/2011
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