Healthcare Provider Details

I. General information

NPI: 1780654582
Provider Name (Legal Business Name): SHIRLEY R JONES MSW LCSWPIP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S LYNCREST PL STE 105
SIOUX FALLS SD
57108-2573
US

IV. Provider business mailing address

6901 S LYNCREST PL STE 105
SIOUX FALLS SD
57108-2573
US

V. Phone/Fax

Practice location:
  • Phone: 605-335-1516
  • Fax: 605-731-0896
Mailing address:
  • Phone: 605-335-1516
  • Fax: 605-731-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1662
License Number StateSD

VII. Legacy identifiers

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

# 1
Identifier6571290
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: