Provider Demographics
NPI:1801362132
Name:SLETTEN, JOLENE DANIELLE (AUD)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:DANIELLE
Last Name:SLETTEN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63645 HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:NE
Mailing Address - Zip Code:68320-3022
Mailing Address - Country:US
Mailing Address - Phone:402-274-8298
Mailing Address - Fax:
Practice Address - Street 1:SOLDIER CENTERED MEDICAL HOME-U.S. ARMY
Practice Address - Street 2:786 D STREET
Practice Address - City:JOINT BASE ELEMENDORF-RICHARDSON
Practice Address - State:AK
Practice Address - Zip Code:99505
Practice Address - Country:US
Practice Address - Phone:907-384-7152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-14
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000942231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist