MEDICARE: NANDINI JONES LICSW

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	104100000X	Social Worker	21452	MN
2	1041C0700X	Clinical Social Worker	21452	MN

General Provider Information

NPI Number	:	1992567655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANDINI JONES LICSW

Provider Business Mailing Address
First Line	:	4444 CENTERVILLE RD STE 235
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55127-3712
Country	:	US
Telephone Number	:	651-289-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 CENTERVILLE RD STE 235
Second Line	:
City	:	WHITE BEAR LAKE
State	:	MN
Zip	:	55127-3712
Country	:	US
Telephone Number	:	651-289-3111
Fax Number	:

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

Provider Enumeration Date	:	01/29/2024
Last Update Date	:	06/27/2024

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