Provider Demographics
NPI:1639725716
Name:EISELE, JOLEEN
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:
Last Name:EISELE
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 1:303 RUTHS LN
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-9032
Mailing Address - Country:US
Mailing Address - Phone:785-456-7940
Mailing Address - Fax:
Practice Address - Street 1:303 RUTHS LN
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-9032
Practice Address - Country:US
Practice Address - Phone:785-456-7940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist