=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548404866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEWETT AND ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2009
-----------------------------------------------------
Last Update Date | 04/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1485 COVENTRY RD
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94518-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-672-9440
-----------------------------------------------------
Fax | 925-672-9440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1485 COVENTRY RD STE 2014
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94518-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-672-9440
-----------------------------------------------------
Fax | 925-672-9440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | LORENA WILLEY-JOHNSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 925-672-9440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355A2700X
-----------------------------------------------------
Taxonomy Name | Audiology Assistant
-----------------------------------------------------
License Number | 9955
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 9955
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------