Provider Demographics
NPI:1023212776
Name:JONES, JERRY LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:134 MICHAEL LN
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2223
Mailing Address - Country:US
Mailing Address - Phone:910-215-7155
Mailing Address - Fax:910-944-5901
Practice Address - Street 1:239 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5430
Practice Address - Country:US
Practice Address - Phone:910-215-7155
Practice Address - Fax:910-944-5901
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2301225200000X
NC8637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2419050AMedicare PIN