Healthcare Provider Details

I. General information

NPI: 1053236901
Provider Name (Legal Business Name): MS. RODESSA LUCITTIA JONES IV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S MICHIGAN AVE. STE 900
CHICAGO IL
60604
US

IV. Provider business mailing address

12027 WINTERBERRY LN
PLAINFIELD IL
60585-5692
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 775-908-3724
Mailing address:
  • Phone: 815-931-2384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberJ52073206632
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: