MEDICARE: MISS KEAIRRA JONES LLMSW

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	1041C0700X	Clinical Social Worker	6851110372	MI

General Provider Information

NPI Number	:	1588362511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KEAIRRA JONES LLMSW

Provider Business Mailing Address
First Line	:	26150 FERNWOOD ST
Second Line	:
City	:	ROSEVILLE
State	:	MI
Zip	:	48066-4470
Country	:	US
Telephone Number	:	313-549-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	41800 HAYES RD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48038-1876
Country	:	US
Telephone Number	:	586-203-2170
Fax Number	:

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

Provider Enumeration Date	:	02/20/2023
Last Update Date	:	02/20/2023

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