Provider Demographics
NPI:1063533107
Name:LOWE, JOLENE LOUISE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:LOUISE
Last Name:LOWE
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 1:210 S 7TH ST
Mailing Address - Street 2:PO BOX 203
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2408
Mailing Address - Country:US
Mailing Address - Phone:785-742-2904
Mailing Address - Fax:
Practice Address - Street 1:909 S 2ND ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2774
Practice Address - Country:US
Practice Address - Phone:785-742-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)