Basic Information
| Provider Information | |||||||||
| NPI: | 1780705525 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MA CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11850 EDGEWATER DR APT 820 | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441076400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168492306 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6606 CARNEGIE AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441034622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163611414 | ||||||||
| FaxNumber: | 2164261383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 7595 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.