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NPI Code Detail

MEDICARE: MRS. COLLEEN MARY JEWELL MA LLP

MEDICARE: MRS. COLLEEN MARY JEWELL MA LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist6301010643MI

General Provider Information

NPI Number : 1619097300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN MARY JEWELL MA LLP
Provider Business Mailing Address
First Line : 10299 GRAND RIVER RD STE I
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-9558
Country : US
Telephone Number : 810-844-7300
Fax Number :
Provider Business Practice Location Address
First Line : 10299 GRAND RIVER RD STE I
Second Line :
City : BRIGHTON
State : MI
Zip : 48116-9558
Country : US
Telephone Number : 810-844-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 07/08/2007

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