Provider Demographics
NPI:1720210230
Name:JONES-CALLICUTT, QUASHEBA (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:QUASHEBA
Middle Name:
Last Name:JONES-CALLICUTT
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:QUASHEBA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1034
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1034
Mailing Address - Country:US
Mailing Address - Phone:870-702-4911
Mailing Address - Fax:
Practice Address - Street 1:2424 DOUBLE CHURCHES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909
Practice Address - Country:US
Practice Address - Phone:706-324-6112
Practice Address - Fax:706-596-8259
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
GASLP010783235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist