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Individual

MISS JAELYN MARICLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1500 LEE ST, ALEXANDRIA, LA 71301-6234
(318) 625-7050
Mailing address
10 BROWN DOYLE RD, PITKIN, LA 70656-2004
(318) 452-1717

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
011331500
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
011331500
LA
Enumeration date
06/04/2021
Last updated
06/04/2021
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