Provider Demographics
NPI:1992085666
Name:JONES, DOMINIQUE RENE (MA CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DOMINIQUE
Middle Name:RENE
Last Name:JONES
Suffix:
Gender:F
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 1:106 DEREK AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-3262
Mailing Address - Country:US
Mailing Address - Phone:315-436-7381
Mailing Address - Fax:
Practice Address - Street 1:428 S ALVORD ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2720
Practice Address - Country:US
Practice Address - Phone:315-435-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist