Provider Demographics
NPI:1073190435
Name:JONES, STEPHANIE (LMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 FAIRFIELD AVE STE 265
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-3416
Mailing Address - Country:US
Mailing Address - Phone:260-492-9334
Mailing Address - Fax:
Practice Address - Street 1:5800 FAIRFIELD AVE STE 265
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-3416
Practice Address - Country:US
Practice Address - Phone:260-492-9334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3308778A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker