Provider Demographics
NPI:1891041620
Name:JEWELL, KATIE (MS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HUMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16363 E FREMONT AVE
Mailing Address - Street 2:APT 123
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16363 E FREMONT AVE
Practice Address - Street 2:APT 123
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-2200
Practice Address - Country:US
Practice Address - Phone:651-237-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist