Provider Demographics
NPI:1558322487
Name:JONES, LAURA MITCHELL (SLP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:MITCHELL
Last Name:JONES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12192
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2192
Mailing Address - Country:US
Mailing Address - Phone:252-672-8676
Mailing Address - Fax:252-672-8677
Practice Address - Street 1:3310 NEUSE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4110
Practice Address - Country:US
Practice Address - Phone:252-672-8676
Practice Address - Fax:252-672-8677
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411646Medicaid
NC1265NOtherBC