Provider Demographics
NPI:1467882183
Name:JEWELL, JENNIFER (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 SPECKERT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2533
Mailing Address - Country:US
Mailing Address - Phone:502-298-0462
Mailing Address - Fax:
Practice Address - Street 1:715 SPECKERT CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2533
Practice Address - Country:US
Practice Address - Phone:502-298-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical