Provider Demographics
NPI:1871257220
Name:BICE, JOLEEN ALEXIS (CLC)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:ALEXIS
Last Name:BICE
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ELM ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-2307
Mailing Address - Country:US
Mailing Address - Phone:815-503-9521
Mailing Address - Fax:
Practice Address - Street 1:211 ELM ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61362-2307
Practice Address - Country:US
Practice Address - Phone:815-503-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL337422174400000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174400000XOther Service ProvidersSpecialist