MEDICARE: ELIZABETH A 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	131998-121	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	16377-131	WI

General Provider Information

NPI Number	:	1497331904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A JONES

Provider Business Mailing Address
First Line	:	124 S BUCKLEY ST
Second Line	:
City	:	ALMA CENTER
State	:	WI
Zip	:	54611-9790
Country	:	US
Telephone Number	:	715-964-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 W 5TH ST
Second Line	:
City	:	NEILLSVILLE
State	:	WI
Zip	:	54456-1818
Country	:	US
Telephone Number	:	715-896-1665
Fax Number	:

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

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/28/2021

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