Basic Information
| Provider Information | |||||||||
| NPI: | 1306165477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 BLYTHE BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282035814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043557760 | ||||||||
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| Practice Location | |||||||||
| Address1: | 44201 DEQUINDRE RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480851117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489645000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2010 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 11197 | NC | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 1278 | NV | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 7101007275 | MI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.