Provider Demographics
NPI:1003272725
Name:FOGELSANGER, JOLENE (LBS)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:FOGELSANGER
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3427
Mailing Address - Country:US
Mailing Address - Phone:717-422-3255
Mailing Address - Fax:
Practice Address - Street 1:131 E MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3522
Practice Address - Country:US
Practice Address - Phone:717-267-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health