Basic Information
| Provider Information | |||||||||
| NPI: | 1548863616 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MACAYLA | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA ED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3260 HIGHWAY 221 | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409777963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708911362 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 130 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305271804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708911362 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 11/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP009675 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.