Individual
JEWELYA M IANNICIELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUDP, LICSW
Contact information
Practice address
5001 112TH ST E, TACOMA, WA 98446-5307
(253) 460-0062
Mailing address
5001 112TH ST E, TACOMA, WA 98446-5307
(253) 460-0062
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00005115
WA
1041C0700X
Clinical Social Worker
LW60174863
WA
Other
Enumeration date
10/18/2007
Last updated
01/05/2025
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