Provider Demographics
NPI:1912527680
Name:JEWELL, JOANNA PATRICE (RPSYCH)
Entity Type:Individual
Prefix:PROF
First Name:JOANNA
Middle Name:PATRICE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:RPSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 OAKTREE LANE SW
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T2V4E4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1511 10 STREET SW, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:CALGARY
Practice Address - State:AB
Practice Address - Zip Code:T2R 1E8
Practice Address - Country:CA
Practice Address - Phone:403-397-9925
Practice Address - Fax:855-503-4849
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3634103T00000X, 103TP2701X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy