Provider Demographics
NPI:1104181072
Name:PRESTON, JONATHAN L (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:L
Last Name:PRESTON
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 1:3654 SWEET RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-9832
Mailing Address - Country:US
Mailing Address - Phone:585-797-7056
Mailing Address - Fax:
Practice Address - Street 1:621 SKYTOP RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-0001
Practice Address - Country:US
Practice Address - Phone:315-443-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004085235Z00000X
NY014158-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist