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General NPI Number Information
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NPI Number | 1467086215
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Entity Type | Individual
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Provider Name | DEBORAH ANN JEWELL CNA2, QMHA
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Gender | Female
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Dates
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Enumeration Date | 03/01/2020
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Last Update Date | 09/21/2021
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Provider Practice Location Address
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Address Line | 2600 SE BELMONT ST
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City | PORTLAND
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State | OR
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Zip | 97214-2916
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Country | US
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Telephone | 971-322-5295
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Fax |
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Provider Business Mailing Address
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Address Line | 5627 NE SIMPSON ST
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City | PORTLAND
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State | OR
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Zip | 97218-2329
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Country | US
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Telephone | 971-322-5295
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 19-QMHA-I-00257
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 201110681CNA
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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