Provider Demographics
NPI:1386658979
Name:JONES, BRENDA (LCSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 OHIO ST STE B
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5825
Mailing Address - Country:US
Mailing Address - Phone:888-474-1344
Mailing Address - Fax:
Practice Address - Street 1:222 OHIO ST STE B
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5825
Practice Address - Country:US
Practice Address - Phone:888-474-1344
Practice Address - Fax:412-206-0128
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138501041C0700X
WI99411231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA857409OtherBC/BS
P05837Medicare UPIN
PA857409OtherBC/BS