Provider Demographics
NPI:1780654582
Name:JONES, SHIRLEY R (MSW LCSWPIP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW LCSWPIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S LYNCREST PL
Mailing Address - Street 2:STE 105
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2573
Mailing Address - Country:US
Mailing Address - Phone:605-335-1516
Mailing Address - Fax:605-731-0896
Practice Address - Street 1:6901 S LYNCREST PL
Practice Address - Street 2:STE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2573
Practice Address - Country:US
Practice Address - Phone:605-335-1516
Practice Address - Fax:605-731-0896
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD16621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6571290Medicaid
SD100404Medicare ID - Type UnspecifiedCMS