Provider Demographics
NPI:1710650783
Name:JOLLEY, CATHERINE (CD, CLC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JOLLEY
Suffix:
Gender:F
Credentials:CD, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8271 RONDALE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8367
Mailing Address - Country:US
Mailing Address - Phone:810-449-7224
Mailing Address - Fax:
Practice Address - Street 1:8271 RONDALE DR
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8367
Practice Address - Country:US
Practice Address - Phone:810-449-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula