Provider Demographics
NPI:1689158313
Name:JONES, SHANTRICE (MS -SLP)
Entity type:Individual
Prefix:
First Name:SHANTRICE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS -SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SANTIAGO CT
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4201
Mailing Address - Country:US
Mailing Address - Phone:863-614-6773
Mailing Address - Fax:
Practice Address - Street 1:365 SANTIAGO CT
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4201
Practice Address - Country:US
Practice Address - Phone:863-614-6773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18182235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002120549Medicaid