Provider Demographics
NPI:1215178041
Name:JONES, SUSANNE (LSW)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5692 ROCKEFELLER CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7133
Mailing Address - Country:US
Mailing Address - Phone:813-310-9880
Mailing Address - Fax:
Practice Address - Street 1:5692 ROCKEFELLER CENTER BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7133
Practice Address - Country:US
Practice Address - Phone:813-310-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1302176104100000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist