Provider Demographics
NPI:1437609161
Name:JONES, JENNIFER CLARK (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CLARK
Last Name:JONES
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 WHITE MARSH RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23888-3300
Mailing Address - Country:US
Mailing Address - Phone:757-346-8343
Mailing Address - Fax:
Practice Address - Street 1:4670 WHITE MARSH RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:VA
Practice Address - Zip Code:23888-3300
Practice Address - Country:US
Practice Address - Phone:757-346-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12040195061744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management