Provider Demographics
NPI:1972190205
Name:COLWELL, JAMIE LIL
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LIL
Last Name:COLWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 KELLS LN
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43344-1286
Mailing Address - Country:US
Mailing Address - Phone:804-840-4462
Mailing Address - Fax:
Practice Address - Street 1:603 KELLS LN
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43344-1286
Practice Address - Country:US
Practice Address - Phone:804-840-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8002691251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services