Provider Demographics
NPI:1396584355
Name:JEWELL, REBECCA ANN (LABA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 HARRISON AVE NW STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5359
Mailing Address - Country:US
Mailing Address - Phone:360-605-0163
Mailing Address - Fax:
Practice Address - Street 1:1415 HARRISON AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5359
Practice Address - Country:US
Practice Address - Phone:360-605-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61231201103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst