Provider Demographics
NPI:1326331679
Name:STEVENS, JOLENE L (SLP)
Entity type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19131 HIGHWAY 10
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:70444-7403
Mailing Address - Country:US
Mailing Address - Phone:985-974-3247
Mailing Address - Fax:
Practice Address - Street 1:42420 OTT LN
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-3234
Practice Address - Country:US
Practice Address - Phone:985-974-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist