Provider Demographics
NPI:1831791169
Name:JONES, ELIZABETH I (CAPSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:I
Last Name:JONES
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8295 STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53544-9449
Mailing Address - Country:US
Mailing Address - Phone:608-574-6949
Mailing Address - Fax:
Practice Address - Street 1:8295 STATE ROAD 39
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:WI
Practice Address - Zip Code:53544-9449
Practice Address - Country:US
Practice Address - Phone:608-574-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1320111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical