Provider Demographics
NPI:1174616247
Name:JONES, ANN LOUISE (MA, LP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 FAIRVIEW AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1244
Mailing Address - Country:US
Mailing Address - Phone:651-636-0107
Mailing Address - Fax:
Practice Address - Street 1:521 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2016
Practice Address - Country:US
Practice Address - Phone:651-636-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2866103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-69195OtherMEDICA
MN89225OtherHEALTH PARTNERS
MN43D11JOOtherBLUE CROSS BLUE SHIELD