Provider Demographics
NPI:1962743781
Name:JONES, DAVID LEONARD (HIS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEONARD
Last Name:JONES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 SOUTHWEST BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2468
Mailing Address - Country:US
Mailing Address - Phone:573-635-3557
Mailing Address - Fax:573-635-6048
Practice Address - Street 1:1431 SOUTHWEST BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2468
Practice Address - Country:US
Practice Address - Phone:573-635-3557
Practice Address - Fax:573-635-6048
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO413237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist