Basic Information
| Provider Information | |||||||||
| NPI: | 1366486466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JOCELYN | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.S.CCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | FAIRCHILD AFB | ||||||||
| State: | WA | ||||||||
| PostalCode: | 990112102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092442736 | ||||||||
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| Practice Location | |||||||||
| Address1: | ST LUKE'S REHAB | ||||||||
| Address2: | 711 S. COWLEY | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 99202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | LL00004189 | WA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.