Provider Demographics
NPI:1255814182
Name:JONES, VIVIENNE MAE
Entity type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:MAE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 BRIARHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-2445
Mailing Address - Country:US
Mailing Address - Phone:817-368-5860
Mailing Address - Fax:
Practice Address - Street 1:331 W HARWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3048
Practice Address - Country:US
Practice Address - Phone:817-285-0654
Practice Address - Fax:817-285-0654
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50595237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist