Provider Demographics
NPI:1619148814
Name:JONES, DANETTE LYNN (MSSW, LICSW, LMFT)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:MSSW, LICSW, LMFT
Other - Prefix:
Other - First Name:DANETTE
Other - Middle Name:JONES
Other - Last Name:MARTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW, LICSW, LMFT
Mailing Address - Street 1:11812 WAYZATA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-2012
Mailing Address - Country:US
Mailing Address - Phone:651-642-1709
Mailing Address - Fax:952-922-7222
Practice Address - Street 1:11812 WAYZATA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2012
Practice Address - Country:US
Practice Address - Phone:651-642-1709
Practice Address - Fax:952-922-7222
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN73501041C0700X
MN735106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3G538MAOtherBCBS