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NPI Code Detail

MEDICARE: EDLYN N JONES PHD, HSPP

MEDICARE: EDLYN N JONES PHD, HSPP
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
1103T00000XPsychologist20040806IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407890445
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDLYN N JONES PHD, HSPP
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line : STE 130 PROVIDER ENROLLMENT
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6820 PARKDALE PLACE
Second Line : SUITE 115
City : INDIANAPOLIS
State : IN
Zip : 46254-4699
Country : US
Telephone Number : 317-329-7300
Fax Number : 317-329-7325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2006
Last Update Date : 11/20/2020

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Directions to “ EDLYN N JONES PHD, HSPP” Practice Location

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