Provider Demographics
NPI:1720358955
Name:JONES, AMANDA SPEAR (MED CCC-SLP BCBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SPEAR
Last Name:JONES
Suffix:
Gender:F
Credentials:MED CCC-SLP BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1639
Mailing Address - Country:US
Mailing Address - Phone:315-446-3220
Mailing Address - Fax:
Practice Address - Street 1:960 SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1639
Practice Address - Country:US
Practice Address - Phone:315-446-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-09-6211103K00000X
NY018703-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst