Provider Demographics
NPI:1548771124
Name:JONES, SUSAN CARR (MA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:CARR
Last Name:JONES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-3415
Mailing Address - Country:US
Mailing Address - Phone:276-956-8115
Mailing Address - Fax:
Practice Address - Street 1:25 BERNARD RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-6614
Practice Address - Country:US
Practice Address - Phone:540-483-5138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000586235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist