Provider Demographics
NPI:1851430888
Name:JONES, CARMEN L (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:PROF
Other - First Name:CARMEN
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:10700 SHADY GLADE LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73151-9496
Mailing Address - Country:US
Mailing Address - Phone:405-330-2223
Mailing Address - Fax:405-330-2253
Practice Address - Street 1:2600 LINDA LN
Practice Address - Street 2:SUITE 5
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3735
Practice Address - Country:US
Practice Address - Phone:405-330-2223
Practice Address - Fax:405-330-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK928235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100645570AMedicaid