Provider Demographics
NPI:1174282818
Name:JONES, THEODORE MAYFIELD
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:MAYFIELD
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75255 VISTA CORONA
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-9022
Mailing Address - Country:US
Mailing Address - Phone:760-609-8888
Mailing Address - Fax:
Practice Address - Street 1:75255 VISTA CORONA
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-9022
Practice Address - Country:US
Practice Address - Phone:760-609-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA69732355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant