Provider Demographics
NPI:1609126713
Name:MCKELL, JONNA TINER (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JONNA
Middle Name:TINER
Last Name:MCKELL
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 1:4 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2511
Mailing Address - Country:US
Mailing Address - Phone:205-871-3878
Mailing Address - Fax:205-871-3902
Practice Address - Street 1:4 OFFICE PARK CIR
Practice Address - Street 2:SUITE 301
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2511
Practice Address - Country:US
Practice Address - Phone:205-871-3878
Practice Address - Fax:205-871-3902
Is Sole Proprietor?:No
Enumeration Date:2012-09-16
Last Update Date:2012-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist