MEDICARE: MARY KATHERINE JONES LCSW

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	2013015422	MO

General Provider Information

NPI Number	:	1821422510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHERINE JONES LCSW

Provider Business Mailing Address
First Line	:	2032 E KEARNEY ST
Second Line	:	SUITE 204
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-4610
Country	:	US
Telephone Number	:	417-838-8266
Fax Number	:	417-869-8400

Provider Business Practice Location Address
First Line	:	2032 E KEARNEY ST
Second Line	:	SUITE 204
City	:	SPRINGFIELD
State	:	MO
Zip	:	65803-4610
Country	:	US
Telephone Number	:	417-838-8266
Fax Number	:	417-869-8400

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

Provider Enumeration Date	:	08/29/2013
Last Update Date	:	08/29/2013

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