Provider Demographics
NPI:1093948838
Name:WIESE, JOLENE CATHERINE (CMT)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:CATHERINE
Last Name:WIESE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:CATHERINE
Other - Last Name:CHENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5001 AMERICAN BLVD W STE 945
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-1162
Mailing Address - Country:US
Mailing Address - Phone:952-835-6653
Mailing Address - Fax:952-835-3895
Practice Address - Street 1:5001 AMERICAN BLVD W STE 945
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-1162
Practice Address - Country:US
Practice Address - Phone:952-835-6653
Practice Address - Fax:952-835-3895
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist