Provider Demographics
NPI:1891902920
Name:JONES, GARY LEE (MA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6185 LAYTON ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-3425
Mailing Address - Country:US
Mailing Address - Phone:909-989-1931
Mailing Address - Fax:
Practice Address - Street 1:270 E 7TH ST
Practice Address - Street 2:1C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6602
Practice Address - Country:US
Practice Address - Phone:909-981-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 923231HA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner