Provider Demographics
NPI:1124167085
Name:JONES, MARJANI DESUE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARJANI
Middle Name:DESUE
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 1:1609 MARTIN LUTHER KING AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-2801
Mailing Address - Country:US
Mailing Address - Phone:941-301-6858
Mailing Address - Fax:
Practice Address - Street 1:1609 MARTIN LUTHER KING AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-2801
Practice Address - Country:US
Practice Address - Phone:941-301-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6374235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888490196Medicaid