Provider Demographics
NPI:1134147952
Name:JONES, JENNIFER KELLY (LPC, MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KELLY
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 SUN VALLEY DR
Mailing Address - Street 2:SUITE #209
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2318
Mailing Address - Country:US
Mailing Address - Phone:262-646-8288
Mailing Address - Fax:262-646-8255
Practice Address - Street 1:2301 SUN VALLEY DR
Practice Address - Street 2:SUITE #209
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2318
Practice Address - Country:US
Practice Address - Phone:262-646-8288
Practice Address - Fax:262-646-8255
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3145-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40926300Medicaid