Provider Demographics
NPI:1558737130
Name:JONES, LISA (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
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 1:1641 SPORTSMAN LN
Mailing Address - Street 2:
Mailing Address - City:VAN ALSTYNE
Mailing Address - State:TX
Mailing Address - Zip Code:75495-8177
Mailing Address - Country:US
Mailing Address - Phone:214-491-0222
Mailing Address - Fax:
Practice Address - Street 1:630 N COLLINS ST
Practice Address - Street 2:
Practice Address - City:COLBERT
Practice Address - State:OK
Practice Address - Zip Code:74733-1697
Practice Address - Country:US
Practice Address - Phone:580-296-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3803235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist