Healthcare Provider Details

I. General information

NPI: 1164954616
Provider Name (Legal Business Name): WALTER JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N STATE ST
STANTON MI
48888-9702
US

IV. Provider business mailing address

41521 W 11 MILE RD
NOVI MI
48375-1803
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-7520
  • Fax:
Mailing address:
  • Phone: 248-299-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: