Provider Demographics
NPI:1679332688
Name:DE JESUS, ALDOUSCON (SLP)
Entity type:Individual
Prefix:
First Name:ALDOUSCON
Middle Name:
Last Name:DE JESUS
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6938 BAIRD ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4698
Mailing Address - Country:US
Mailing Address - Phone:925-858-1518
Mailing Address - Fax:
Practice Address - Street 1:6938 BAIRD ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4698
Practice Address - Country:US
Practice Address - Phone:925-858-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20456235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist