Provider Demographics
NPI:1972798700
Name:JONES, HEATHER DANIELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DANIELLE
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-6857
Mailing Address - Country:US
Mailing Address - Phone:479-968-1198
Mailing Address - Fax:479-968-1498
Practice Address - Street 1:1101 S ERIE AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-6857
Practice Address - Country:US
Practice Address - Phone:479-968-1198
Practice Address - Fax:479-968-1498
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist