MEDICARE: JOLEEN ALEXIS BICE CLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	337422	IL
2	174N00000X	Lactation Consultant (Non-RN)	337422	IL

General Provider Information

NPI Number	:	1871257220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOLEEN ALEXIS BICE CLC

Provider Business Mailing Address
First Line	:	211 ELM ST
Second Line	:
City	:	SPRING VALLEY
State	:	IL
Zip	:	61362-2307
Country	:	US
Telephone Number	:	815-503-9521
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 ELM ST
Second Line	:
City	:	SPRING VALLEY
State	:	IL
Zip	:	61362-2307
Country	:	US
Telephone Number	:	815-503-9521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	07/24/2022

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