Provider Demographics
NPI:1689151797
Name:UMHOLTZ, JOLENE C
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:C
Last Name:UMHOLTZ
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 1:800 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1916
Mailing Address - Country:US
Mailing Address - Phone:814-684-7632
Mailing Address - Fax:
Practice Address - Street 1:800 W 13TH ST
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1916
Practice Address - Country:US
Practice Address - Phone:814-684-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004937L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist