Provider Demographics
NPI:1013405786
Name:JONES, HERBERT LEIGHTON (CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:LEIGHTON
Last Name:JONES
Suffix:
Gender:M
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7548
Mailing Address - Street 2:
Mailing Address - City:GWYNN OAK
Mailing Address - State:MD
Mailing Address - Zip Code:21207-0548
Mailing Address - Country:US
Mailing Address - Phone:703-309-3623
Mailing Address - Fax:
Practice Address - Street 1:5107 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-7056
Practice Address - Country:US
Practice Address - Phone:703-309-3623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist