Provider Demographics
NPI:1881171908
Name:DUBOIS, JONATHAN RAY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAY
Last Name:DUBOIS
Suffix:
Gender:M
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 1:5224 DRISCOLL CT
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-1002
Mailing Address - Country:US
Mailing Address - Phone:321-330-5486
Mailing Address - Fax:
Practice Address - Street 1:606 SHERBURN CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9017
Practice Address - Country:US
Practice Address - Phone:407-810-2773
Practice Address - Fax:407-867-6203
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist