Provider Demographics
NPI:1770297483
Name:JONES-RICHARDSON, LADAWN
Entity type:Individual
Prefix:
First Name:LADAWN
Middle Name:
Last Name:JONES-RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24717 HASS ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-3134
Mailing Address - Country:US
Mailing Address - Phone:248-720-9029
Mailing Address - Fax:
Practice Address - Street 1:24634 5 MILE RD STE 19
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3667
Practice Address - Country:US
Practice Address - Phone:248-720-9029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care