Provider Demographics
NPI:1124290846
Name:JONES, TANYA LEE (MSW)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4038
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:105 EAST QUINCY STREET
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MO
Practice Address - Zip Code:63452
Practice Address - Country:US
Practice Address - Phone:573-215-2715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080236161041C0700X
IL149.0129461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO127510001Medicare PIN