Provider Demographics
NPI:1316185879
Name:JONES, KATRINA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 W PATTERSON AVE
Mailing Address - Street 2:2R
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:800-514-4603
Practice Address - Street 1:5024 W PATTERSON AVE
Practice Address - Street 2:2R
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3413
Practice Address - Country:US
Practice Address - Phone:810-513-7178
Practice Address - Fax:800-514-4603
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL1-12-11400103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst