Provider Demographics
NPI:1396396628
Name:JONES, SUSAN
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8912 WOODY TRL
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8413
Mailing Address - Country:US
Mailing Address - Phone:815-347-0595
Mailing Address - Fax:
Practice Address - Street 1:1920 LOTUS DR
Practice Address - Street 2:
Practice Address - City:ROUND LAKE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60073-1122
Practice Address - Country:US
Practice Address - Phone:847-270-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool