Provider Demographics
NPI:1982175683
Name:JONES, CONSTANCE L (MS-CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14127 MARACAIBO RD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-6517
Mailing Address - Country:US
Mailing Address - Phone:510-710-2188
Mailing Address - Fax:
Practice Address - Street 1:14127 MARACAIBO RD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-6517
Practice Address - Country:US
Practice Address - Phone:510-710-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13626235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist