Provider Demographics
NPI:1548793235
Name:NEWELL, JACLENE ELIZABETH (MS)
Entity Type:Individual
Prefix:
First Name:JACLENE
Middle Name:ELIZABETH
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:OWEN
Mailing Address - State:WI
Mailing Address - Zip Code:54460-0065
Mailing Address - Country:US
Mailing Address - Phone:715-229-0330
Mailing Address - Fax:715-229-0331
Practice Address - Street 1:112 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OWEN
Practice Address - State:WI
Practice Address - Zip Code:54460-9776
Practice Address - Country:US
Practice Address - Phone:715-229-0330
Practice Address - Fax:715-229-0331
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health