Provider Demographics
NPI:1508347519
Name:JONES, SHALEETA (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SHALEETA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14220 W SIDE BLVD APT 301
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6234
Mailing Address - Country:US
Mailing Address - Phone:919-423-1563
Mailing Address - Fax:
Practice Address - Street 1:3320 BENSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1035
Practice Address - Country:US
Practice Address - Phone:410-644-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist