Provider Demographics
NPI:1417357054
Name:JEWELL, KERRIE (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 E 1450TH AVE
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-7746
Mailing Address - Country:US
Mailing Address - Phone:217-240-1853
Mailing Address - Fax:
Practice Address - Street 1:8350 E 1450TH AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-7746
Practice Address - Country:US
Practice Address - Phone:217-240-1853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL32084101YA0400X
IL1490224091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)