Provider Demographics
NPI:1497331904
Name:JONES, ELIZABETH A
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
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 1:124 S BUCKLEY ST
Mailing Address - Street 2:
Mailing Address - City:ALMA CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:54611-9790
Mailing Address - Country:US
Mailing Address - Phone:715-964-1233
Mailing Address - Fax:
Practice Address - Street 1:510 W 5TH ST
Practice Address - Street 2:
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1818
Practice Address - Country:US
Practice Address - Phone:715-896-1665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131998-121104100000X
WI16377-131101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker