MEDICARE: KATRINA JONES M.A., BCBA

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	1-12-11400	IL

General Provider Information

NPI Number	:	1316185879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA JONES M.A., BCBA

Provider Business Mailing Address
First Line	:	5024 W PATTERSON AVE
Second Line	:	2R
City	:	CHICAGO
State	:	IL
Zip	:	60641-3413
Country	:	US
Telephone Number	:
Fax Number	:	800-514-4603

Provider Business Practice Location Address
First Line	:	5024 W PATTERSON AVE
Second Line	:	2R
City	:	CHICAGO
State	:	IL
Zip	:	60641-3413
Country	:	US
Telephone Number	:	810-513-7178
Fax Number	:	800-514-4603

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

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	02/22/2013

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