Provider Demographics
NPI:1821006479
Name:JONES, ANGELA SLICE (MSP, CCC-SLP,BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:SLICE
Last Name:JONES
Suffix:
Gender:F
Credentials:MSP, 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 1:124 BAILEY SLICE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8900
Mailing Address - Country:US
Mailing Address - Phone:803-345-8327
Mailing Address - Fax:
Practice Address - Street 1:124 BAILEY SLICE RD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8900
Practice Address - Country:US
Practice Address - Phone:803-360-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3012235Z00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0289Medicaid