Provider Demographics
NPI:1508986019
Name:JONES, COLLETTA M (BS)
Entity Type:Individual
Prefix:MS
First Name:COLLETTA
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5137
Mailing Address - Country:US
Mailing Address - Phone:208-733-1318
Mailing Address - Fax:208-733-1766
Practice Address - Street 1:296 MONROE ST
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5137
Practice Address - Country:US
Practice Address - Phone:208-733-1318
Practice Address - Fax:208-733-1766
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8076658Medicaid