MEDICARE: LACIE 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	104100000X	Social Worker	6801014803	MI

General Provider Information

NPI Number	:	1326076860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACIE JONES

Provider Business Mailing Address
First Line	:	1110 ELDON BAKER DR
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-1923
Country	:	US
Telephone Number	:	810-744-3600
Fax Number	:	810-744-2597

Provider Business Practice Location Address
First Line	:	32932 WARREN RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-3095
Country	:	US
Telephone Number	:	810-744-3600
Fax Number	:	810-744-2597

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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Directions to “ LACIE JONES ” Practice Location

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