Healthcare Provider Details

I. General information

NPI: 1851548473
Provider Name (Legal Business Name): JESSICA L JONES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2008
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CASON AVE
BASTROP LA
71220-5005
US

IV. Provider business mailing address

8437 COLLINSTON RD
BASTROP LA
71220-8131
US

V. Phone/Fax

Practice location:
  • Phone: 318-974-5025
  • Fax: 318-974-5175
Mailing address:
  • Phone: 318-237-9968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9857
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: