Jasmine Dominique Jones

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

Practice address

19041 Willow Ave
Country Club Hills, IL 60478-5740

Phone

(708) 405-8990

NPI assigned

Nov 18, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1902441603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19041 WILLOW AVE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604785740",
            "telephone_number": "312-758-6617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19041 WILLOW AVE",
            "city": "COUNTRY CLUB HILLS",
            "state": "IL",
            "postal_code": "604785740",
            "telephone_number": "708-405-8990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "JASMINE",
        "middle_name": "DOMINIQUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-18",
        "last_updated": "2021-08-20",
        "certification_date": "2021-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "00000000",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "na",
            "affiliation": "N",
            "address_1": "19041 Willow Ave",
            "city": "Country Club Hills",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604785740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elona Johnson
• Geralyn L Johnson
• Gwendolyn L Johnson
• Leonna Johnson
• William Johnson Jr., M.S.
• Karina L Jordan
• Joshjoe Incorporated
• Katrina Lake MD LLC (Live. Love. Wellness MD)
• Keena Kelly, CASE MANAGER
• Veronica Lynette Kiarie, RN

• Clinical Child & Adolescent Psychologist in Country Club Hills, IL
• Providers in Country Club Hills, IL by specialty
• Clinical Child & Adolescent Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.