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NPI Code Detail

MEDICARE: SUSAN JONES

MEDICARE:   SUSAN  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
1103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1396396628
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN JONES
Provider Business Mailing Address
First Line : 8912 WOODY TRL
Second Line :
City : WONDER LAKE
State : IL
Zip : 60097-8413
Country : US
Telephone Number : 815-347-0595
Fax Number :
Provider Business Practice Location Address
First Line : 1920 LOTUS DR
Second Line :
City : ROUND LAKE HEIGHTS
State : IL
Zip : 60073-1122
Country : US
Telephone Number : 847-270-9970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2019
Last Update Date : 09/27/2019

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Directions to “ SUSAN JONES ” Practice Location

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