Healthcare Provider Details

I. General information

NPI: 1619707445
Provider Name (Legal Business Name): CARLIE J JONES SLP-ASSITANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GLADES RD STE 400
BOCA RATON FL
33431-6469
US

IV. Provider business mailing address

15280 NW 79TH CT STE 200
MIAMI LAKES FL
33016-5873
US

V. Phone/Fax

Practice location:
  • Phone: 561-750-2100
  • Fax: 561-750-0889
Mailing address:
  • Phone: 305-558-3724
  • Fax: 786-907-4485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number43998
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: