Healthcare Provider Details

I. General information

NPI: 1528492642
Provider Name (Legal Business Name): JOYCE E JADWIN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5310 E MAIN ST SUITE 102
COLUMBUS OH
43213-2598
US

IV. Provider business mailing address

5310 EAST MAIN STREET SUITE 102
COLUMBUS OH
43213
US

V. Phone/Fax

Practice location:
  • Phone: 614-751-1090
  • Fax: 614-751-1091
Mailing address:
  • Phone: 614-751-1090
  • Fax: 614-751-1091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6954
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: