Provider Demographics
NPI:1447771787
Name:JONES, JADE (APN)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1957 EUCLID AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1864
Mailing Address - Country:US
Mailing Address - Phone:708-466-1956
Mailing Address - Fax:
Practice Address - Street 1:3805 E MAIN ST STE J
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2487
Practice Address - Country:US
Practice Address - Phone:630-646-5200
Practice Address - Fax:630-377-3762
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2090161072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry