Provider Demographics
NPI:1255519047
Name:BRYANT-JONES, MARIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BRYANT-JONES
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7334 KESHISHIAN CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-5321
Mailing Address - Country:US
Mailing Address - Phone:727-320-4098
Mailing Address - Fax:
Practice Address - Street 1:7334 KESHISHIAN CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-5321
Practice Address - Country:US
Practice Address - Phone:727-320-4098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0700X
FLSA8958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890813300Medicaid