Healthcare Provider Details

I. General information

NPI: 1912527680
Provider Name (Legal Business Name): JOANNA PATRICE JEWELL RPSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 10 STREET SW, 2ND FLOOR
CALGARY AB
T2R 1E8
CA

IV. Provider business mailing address

168 OAKTREE LANE SW
CALGARY ALBERTA
T2V4E4
CA

V. Phone/Fax

Practice location:
  • Phone: 403-397-9925
  • Fax: 855-503-4849
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3634
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number3634
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number3634
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: