| Doctor Name: | JOLENE ROSE |
| NPI Number: | 1154720498 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LAC-LAC-LIC-4136 |
| Business Practice Address: | 730 N Montana St Dillon, MT - 597258497 |
| Business Phone Number: | 4066834305 |
| Business Fax Number: | 4066839767 |
| Mailing Address: | Po Box 527, DILLON |
| State: | MT |
| Postal Code: | 597250527 |
| Phone Number: | 4066834305 |
| Fax Number: | 4066839767 |
| NPI Enumeration Date: | 08/21/2014 |
| NPI Last Update Date: | 08/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LAC-LAC-LIC-4136 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |