Provider Demographics
NPI:1548782246
Name:JONES, RACHEL LYNN (ST)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:JONES
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 VINEYARD DR E
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6068
Mailing Address - Country:US
Mailing Address - Phone:870-476-5639
Mailing Address - Fax:
Practice Address - Street 1:4228 VINEYARD DR E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6068
Practice Address - Country:US
Practice Address - Phone:870-476-5639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
MSS4464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist