Provider Demographics
NPI:1023095346
Name:JONES, DONALD E (LCSW)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:E
Last Name:JONES
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 WESTPORT RDG
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-8988
Mailing Address - Country:US
Mailing Address - Phone:815-455-6463
Mailing Address - Fax:815-788-1345
Practice Address - Street 1:100 N WALKUP AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4383
Practice Address - Country:US
Practice Address - Phone:815-444-1090
Practice Address - Fax:815-788-1345
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149 -- 0042191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632141OtherBC/BS
IL545749OtherVALUE OPTIONS
IL211978Medicare ID - Type Unspecified