Healthcare Provider Details

I. General information

NPI: 1477979045
Provider Name (Legal Business Name): ROLANDA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SOUTHFIELD DR
PLAINFIELD IN
46168-2464
US

IV. Provider business mailing address

PO BOX 4323
TERRE HAUTE IN
47804-0323
US

V. Phone/Fax

Practice location:
  • Phone: 317-837-9726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006411A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: