Provider Demographics
NPI:1780155697
Name:JONES, ALEXANDRA MARIE (MS, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:ALEXANDRA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 N ISABELL AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1358
Mailing Address - Country:US
Mailing Address - Phone:309-453-5755
Mailing Address - Fax:
Practice Address - Street 1:2315 N STERLING AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-3124
Practice Address - Country:US
Practice Address - Phone:309-672-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242005171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242005171Medicaid