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NPI Code Detail

MEDICARE: STACEY M JONES

MEDICARE: STACEY M 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1477314979
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY M JONES
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-387-4313
Fax Number :
Provider Business Practice Location Address
First Line : 109 E WINONA AVE
Second Line :
City : WARSAW
State : IN
Zip : 46580-4400
Country : US
Telephone Number : 574-387-4313
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2024
Last Update Date : 08/08/2025

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Directions to “ STACEY M JONES ” Practice Location

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