Provider Demographics
NPI:1639418569
Name:BLEY, JONNA MEGAN (MSP, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JONNA
Middle Name:MEGAN
Last Name:BLEY
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 LATIMER ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1828
Mailing Address - Country:US
Mailing Address - Phone:843-752-2711
Mailing Address - Fax:
Practice Address - Street 1:134 LATIMER ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1828
Practice Address - Country:US
Practice Address - Phone:843-752-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist