Provider Demographics
NPI:1780930198
Name:JONES, MICHAEL RUTHERFORD (MA, PHD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:RUTHERFORD
Last Name:JONES
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SUFFOLK CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5218
Mailing Address - Country:US
Mailing Address - Phone:312-307-6411
Mailing Address - Fax:
Practice Address - Street 1:122 S MICHIGAN AVE STE 1452
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6179
Practice Address - Country:US
Practice Address - Phone:312-307-6411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490167091041C0700X
NMC-095461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical