Provider Demographics
NPI:1689724825
Name:JONES, LISA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 NATIONS FORD RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-8014
Mailing Address - Country:US
Mailing Address - Phone:704-464-8564
Mailing Address - Fax:704-749-8708
Practice Address - Street 1:7950 NATIONS FORD RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-8014
Practice Address - Country:US
Practice Address - Phone:704-464-8564
Practice Address - Fax:704-749-8708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist