Provider Demographics
NPI:1881858793
Name:JONES, KELLY MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1388
Mailing Address - Country:US
Mailing Address - Phone:304-462-5718
Mailing Address - Fax:304-462-8272
Practice Address - Street 1:111 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1388
Practice Address - Country:US
Practice Address - Phone:304-462-5718
Practice Address - Fax:304-462-8272
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-1198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist