Provider Demographics
NPI:1275900490
Name:JONES, CJ (MA 60554080)
Entity Type:Individual
Prefix:
First Name:CJ
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MA 60554080
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 SE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2215
Mailing Address - Country:US
Mailing Address - Phone:702-742-3025
Mailing Address - Fax:
Practice Address - Street 1:1908 SE 7TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2215
Practice Address - Country:US
Practice Address - Phone:702-742-3025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60554080225700000X
NVNVMT 4554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist