Provider Demographics
NPI:1992087423
Name:JONES, HEATHER WILLIS (MSP/CCC-SLP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:WILLIS
Last Name:JONES
Suffix:
Gender:F
Credentials:MSP/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 ROBERTS FARM RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-7241
Mailing Address - Country:US
Mailing Address - Phone:803-447-8877
Mailing Address - Fax:855-252-9912
Practice Address - Street 1:105 ROBERTS FARM RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-7241
Practice Address - Country:US
Practice Address - Phone:803-447-8877
Practice Address - Fax:855-252-9912
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-10
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1217Medicaid