Provider Demographics
NPI:1548082001
Name:JONES, DIANE (SCHOOL PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8548 LARKSPUR TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-0650
Mailing Address - Country:US
Mailing Address - Phone:708-899-0821
Mailing Address - Fax:
Practice Address - Street 1:8548 LARKSPUR TER
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-0650
Practice Address - Country:US
Practice Address - Phone:708-899-0821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1353063103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool