MEDICARE: LATIA T JONES SAC, CPS

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	175T00000X	Peer Specialist		WI

General Provider Information

NPI Number	:	1295247302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATIA T JONES SAC, CPS

Provider Business Mailing Address
First Line	:	1550 N EDISON ST APT 202
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 N EDISON ST APT 202
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3166
Country	:	US
Telephone Number	:	262-617-3957
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	05/14/2025

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