Provider Demographics
NPI:1780705525
Name:JONES, LISA ANN (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ANN
Last Name: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 1:11850 EDGEWATER DR APT 820
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-6400
Mailing Address - Country:US
Mailing Address - Phone:216-849-2306
Mailing Address - Fax:
Practice Address - Street 1:6606 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4622
Practice Address - Country:US
Practice Address - Phone:216-361-1414
Practice Address - Fax:216-426-1383
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7595235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist