Provider Demographics
NPI:1902441603
Name:JONES, JASMINE DOMINIQUE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:DOMINIQUE
Last Name:JONES
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 1:19041 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5740
Mailing Address - Country:US
Mailing Address - Phone:312-758-6617
Mailing Address - Fax:
Practice Address - Street 1:19041 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:COUNTRY CLUB HILLS
Practice Address - State:IL
Practice Address - Zip Code:60478-5740
Practice Address - Country:US
Practice Address - Phone:708-405-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000OtherN/A