Provider Demographics
NPI:1629570650
Name:JONES, ELLEN (LSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 LINCOLN WAY E STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-3220
Mailing Address - Country:US
Mailing Address - Phone:574-360-4066
Mailing Address - Fax:866-843-2486
Practice Address - Street 1:611 LINCOLN WAY E STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-3220
Practice Address - Country:US
Practice Address - Phone:574-360-4066
Practice Address - Fax:866-843-2486
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker