Provider Demographics
NPI:1033300900
Name:JONES, AUDREY (BA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 E BROAD ST 3RD FLOOR
Mailing Address - Street 2:CHILDREN'S HOSPITAL GUIDANCE CENTER
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205
Mailing Address - Country:US
Mailing Address - Phone:614-355-8000
Mailing Address - Fax:614-355-8018
Practice Address - Street 1:187 W. SCHROCK RD
Practice Address - Street 2:CHILDREN'S HOSPITAL GUIDANCE CENTER
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082
Practice Address - Country:US
Practice Address - Phone:614-355-8315
Practice Address - Fax:614-355-8381
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicare UPIN