Provider Demographics
NPI:1619337953
Name:JONES, BREONNA
Entity Type:Individual
Prefix:
First Name:BREONNA
Middle Name:
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 1:25870 VILLAGE GREEN BLVD
Mailing Address - Street 2:APT 208
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-3047
Mailing Address - Country:US
Mailing Address - Phone:313-269-0130
Mailing Address - Fax:
Practice Address - Street 1:19532 WESTPHALIA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1734
Practice Address - Country:US
Practice Address - Phone:313-269-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other