Provider Demographics
NPI:1457701393
Name:REID, JONNEL (SLP-A)
Entity Type:Individual
Prefix:MISS
First Name:JONNEL
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 NE 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-7034
Mailing Address - Country:US
Mailing Address - Phone:352-401-7916
Mailing Address - Fax:352-368-7607
Practice Address - Street 1:521 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-7034
Practice Address - Country:US
Practice Address - Phone:352-401-7916
Practice Address - Fax:352-368-7607
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI1957235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI1957OtherSPEECH PATHOLOGY ASSISTANT LICENSE