Provider Demographics
NPI:1942520929
Name:EMORY, JON P
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:P
Last Name:EMORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 W ADDISON ST
Mailing Address - Street 2:APT 61
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4429
Mailing Address - Country:US
Mailing Address - Phone:217-520-1486
Mailing Address - Fax:
Practice Address - Street 1:642 W ADDISON ST
Practice Address - Street 2:APT 61
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4429
Practice Address - Country:US
Practice Address - Phone:217-520-1486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst