Provider Demographics
NPI:1962285577
Name:JELACIC, CLARA JEAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CLARA
Middle Name:JEAN
Last Name:JELACIC
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7711 FREELAND CT
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53129-1658
Mailing Address - Country:US
Mailing Address - Phone:414-210-0088
Mailing Address - Fax:414-509-1630
Practice Address - Street 1:7711 FREELAND CT
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:WI
Practice Address - Zip Code:53129-1658
Practice Address - Country:US
Practice Address - Phone:414-210-0088
Practice Address - Fax:414-509-1630
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16489-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist