Provider Demographics
NPI:1972521029
Name:JONES, JEANINE M (MSW)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59342 PINE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3720
Mailing Address - Country:US
Mailing Address - Phone:586-453-9412
Mailing Address - Fax:248-846-8027
Practice Address - Street 1:43157 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1955
Practice Address - Country:US
Practice Address - Phone:586-453-9412
Practice Address - Fax:248-846-8027
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010810451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP59490010Medicare UPIN