Healthcare Provider Details

I. General information

NPI: 1548175847
Provider Name (Legal Business Name): HEATHER M JONES PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 CORPORATE CENTER DR STE 200
OCONOMOWOC WI
53066-4883
US

IV. Provider business mailing address

N66W38360 DEER CREEK CT
OCONOMOWOC WI
53066-6303
US

V. Phone/Fax

Practice location:
  • Phone: 262-450-1319
  • Fax:
Mailing address:
  • Phone: 920-988-1918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP6905
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3359-57
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: