Provider Demographics
NPI:1265835698
Name:KIDWELL, JOYCE (LBSW)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:KIDWELL
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5397 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4538
Mailing Address - Country:US
Mailing Address - Phone:325-232-6931
Mailing Address - Fax:
Practice Address - Street 1:5397 ALAMO DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4538
Practice Address - Country:US
Practice Address - Phone:325-232-6931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34996104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker