Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 20042776 | IN |
NPI | 1043620206 |
---|---|
Provider Name | Dr. Lani M Jones |
First Address | Muncie, IN 47303-1602 |
Second Address | Muncie, IN 47303-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2014 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201252250 | (05) | IN |