MEDICARE: DR. JOYCE E JADWIN PSYD

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
1	103TC0700X	Clinical Psychologist	6954	OH

General Provider Information

NPI Number	:	1528492642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE E JADWIN PSYD

Provider Business Mailing Address
First Line	:	5310 EAST MAIN STREET
Second Line	:	SUITE 102
City	:	COLUMBUS
State	:	OH
Zip	:	43213
Country	:	US
Telephone Number	:	614-751-1090
Fax Number	:	614-751-1091

Provider Business Practice Location Address
First Line	:	5310 E MAIN ST
Second Line	:	SUITE 102
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2598
Country	:	US
Telephone Number	:	614-751-1090
Fax Number	:	614-751-1091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	11/30/2020

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