Provider Demographics
NPI:1104024850
Name:JONES, JUDITH VONETTA (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:VONETTA
Last Name:JONES
Suffix:
Gender:F
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 1:3043 SPRUCEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-2990
Mailing Address - Country:US
Mailing Address - Phone:706-627-8890
Mailing Address - Fax:706-792-9506
Practice Address - Street 1:3043 SPRUCEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-2990
Practice Address - Country:US
Practice Address - Phone:706-627-8890
Practice Address - Fax:706-792-9506
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006375235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist