Healthcare Provider Details

I. General information

NPI: 1104663178
Provider Name (Legal Business Name): JANEL TIFFANY JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4137 SAUK TRL STE 122
RICHTON PARK IL
60471-1253
US

IV. Provider business mailing address

4137 SAUK TRL STE 122
RICHTON PARK IL
60471-1253
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-8598
  • Fax:
Mailing address:
  • Phone: 708-261-5561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: