Healthcare Provider Details

I. General information

NPI: 1831675693
Provider Name (Legal Business Name): MANDISA JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 S INDIANA AVE STE 2NE
CHICAGO IL
60605-2857
US

IV. Provider business mailing address

40 E HURON ST UNIT 4B
CHICAGO IL
60611-5244
US

V. Phone/Fax

Practice location:
  • Phone: 773-599-8922
  • Fax:
Mailing address:
  • Phone: 773-599-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020678
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.01571
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: