Healthcare Provider Details

I. General information

NPI: 1568196137
Provider Name (Legal Business Name): IVY SHENELL JONES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-4767
US

IV. Provider business mailing address

1120 N ARLINGTON HEIGHTS RD
ARLINGTON HEIGHTS IL
60004-4767
US

V. Phone/Fax

Practice location:
  • Phone: 847-342-1554
  • Fax: 847-342-1711
Mailing address:
  • Phone: 847-342-1554
  • Fax: 847-342-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209025073
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: