Provider Demographics
NPI:1518359686
Name:KESLER, JOLENE CLAIRE
Entity Type:Individual
Prefix:MS
First Name:JOLENE
Middle Name:CLAIRE
Last Name:KESLER
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 1:12475 N 69TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9554
Mailing Address - Country:US
Mailing Address - Phone:623-322-7400
Mailing Address - Fax:
Practice Address - Street 1:12475 N 69TH DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-9554
Practice Address - Country:US
Practice Address - Phone:623-322-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5856020101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional