MEDICARE: JENNIFER LAURIE JONES BS

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	101Y00000X	Counselor		LA
2	171M00000X	Case Manager/Care Coordinator		LA

General Provider Information

NPI Number	:	1902313802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAURIE JONES BS

Provider Business Mailing Address
First Line	:	1200 GIBSON CIR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-3348
Country	:	US
Telephone Number	:	318-507-8391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 GIBSON CIR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71112-3348
Country	:	US
Telephone Number	:	318-507-8391
Fax Number	:

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

Provider Enumeration Date	:	01/02/2018
Last Update Date	:	09/11/2018

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