Provider Demographics
NPI:1104671684
Name:AGELOPOULOS, JONELLE EFTHYMIA (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JONELLE
Middle Name:EFTHYMIA
Last Name:AGELOPOULOS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 COWLEY WAY APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6524
Mailing Address - Country:US
Mailing Address - Phone:650-515-6161
Mailing Address - Fax:
Practice Address - Street 1:4282 GENESEE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4986
Practice Address - Country:US
Practice Address - Phone:858-737-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist