Provider Demographics
NPI:1083764799
Name:JONES, JO ANN (DEVELOPMENTAL THERAP)
Entity type:Individual
Prefix:MRS
First Name:JO
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:DEVELOPMENTAL THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 FROG HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IL
Mailing Address - Zip Code:62638
Mailing Address - Country:US
Mailing Address - Phone:217-484-6445
Mailing Address - Fax:
Practice Address - Street 1:156 FROG HILL ROAD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IL
Practice Address - Zip Code:62638
Practice Address - Country:US
Practice Address - Phone:217-484-6445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILJJ49040303103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy