Provider Demographics
NPI:1124312954
Name:JONES, MAUREEN ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ANN
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:71 E CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-8305
Mailing Address - Country:US
Mailing Address - Phone:360-277-2111
Mailing Address - Fax:360-277-2321
Practice Address - Street 1:71 E CAMPUS DR
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-8305
Practice Address - Country:US
Practice Address - Phone:360-277-2111
Practice Address - Fax:360-277-2321
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 00003655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist