Provider Demographics
NPI:1366486466
Name:POWELL, JOCELYN R (MSCCC)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:R
Last Name:POWELL
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011-2102
Mailing Address - Country:US
Mailing Address - Phone:509-244-2736
Mailing Address - Fax:
Practice Address - Street 1:ST LUKE'S REHAB
Practice Address - Street 2:711 S. COWLEY
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202
Practice Address - Country:US
Practice Address - Phone:509-473-6000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist