Provider Demographics
NPI:1619758976
Name:JOLICOEUR, JENINE MARI
Entity Type:Individual
Prefix:
First Name:JENINE
Middle Name:MARI
Last Name:JOLICOEUR
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 1:8795 FOLSOM BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3720
Mailing Address - Country:US
Mailing Address - Phone:916-834-4379
Mailing Address - Fax:916-400-3775
Practice Address - Street 1:8795 FOLSOM BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3720
Practice Address - Country:US
Practice Address - Phone:916-834-4379
Practice Address - Fax:916-400-3775
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6622224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant