MEDICARE: CANDACE MARIE JONAS

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1356116107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE MARIE JONAS

Provider Business Mailing Address
First Line	:	75 CALBREATH CT
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-8001
Country	:	US
Telephone Number	:	636-328-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	11780 BORMAN DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4135
Country	:	US
Telephone Number	:	314-275-0506
Fax Number	:

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

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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Directions to “ CANDACE MARIE JONAS ” Practice Location

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