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General NPI Number Information
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NPI Number | 1013743111
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Entity Type | Individual
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Provider Name | FREDRIQUE RIAN JONES
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 3555 W ARMITAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60647
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Country | US
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Telephone | 773-433-1995
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Fax |
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Provider Business Mailing Address
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Address Line | 5601 S SACRAMENTO AVE
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City | CHICAGO
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State | IL
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Zip | 60629-2130
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Country | US
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Telephone | 614-218-8080
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149.024834
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License Number State | IL
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