MEDICARE: KENESHA JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1033925474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENESHA JONES

Provider Business Mailing Address
First Line	:	10 PETERBORO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 3RD ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-2505
Country	:	US
Telephone Number	:	313-831-3160
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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Directions to “ KENESHA JONES ” Practice Location

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