Provider Demographics
NPI:1659675478
Name:JONES, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5615
Mailing Address - Country:US
Mailing Address - Phone:843-629-8484
Mailing Address - Fax:
Practice Address - Street 1:103 CLAIR DR
Practice Address - Street 2:SUITE A
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6400
Practice Address - Country:US
Practice Address - Phone:864-295-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-09
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3909235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist