Provider Demographics
NPI:1114501103
Name:MICHON, JOLIE CLAIRE
Entity Type:Individual
Prefix:MS
First Name:JOLIE
Middle Name:CLAIRE
Last Name:MICHON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PUJO ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-4378
Mailing Address - Country:US
Mailing Address - Phone:337-436-6622
Mailing Address - Fax:337-436-4403
Practice Address - Street 1:700 PUJO ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-4378
Practice Address - Country:US
Practice Address - Phone:337-436-6622
Practice Address - Fax:337-436-4403
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-06
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child