Provider Demographics
NPI:1154299618
Name:JONES, MIA (MASTERS DEGREE)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 MOSEDALE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-4151
Mailing Address - Country:US
Mailing Address - Phone:847-565-9797
Mailing Address - Fax:
Practice Address - Street 1:32 MOSEDALE ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-4151
Practice Address - Country:US
Practice Address - Phone:847-565-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist