Provider Demographics
NPI:1992838023
Name:JONES, SAMANTHA JILL (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JILL
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 HUDSON RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72858-8738
Mailing Address - Country:US
Mailing Address - Phone:479-857-4246
Mailing Address - Fax:
Practice Address - Street 1:87 SOUTH B ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72858
Practice Address - Country:US
Practice Address - Phone:479-968-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142533721Medicaid