Provider Demographics
NPI:1881366425
Name:LANGE, JOLEE ELAINE
Entity type:Individual
Prefix:
First Name:JOLEE
Middle Name:ELAINE
Last Name:LANGE
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 1:610 E BIDWELL ST STE A
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-4213
Mailing Address - Country:US
Mailing Address - Phone:916-983-2942
Mailing Address - Fax:
Practice Address - Street 1:610 E BIDWELL ST STE A
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4213
Practice Address - Country:US
Practice Address - Phone:916-983-2942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8543237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist