Healthcare Provider Details

I. General information

NPI: 1518800721
Provider Name (Legal Business Name): ELLERY GRACE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 W CALVARY RD
DULUTH MN
55803-1256
US

IV. Provider business mailing address

4235 W CALVARY RD
DULUTH MN
55803-1256
US

V. Phone/Fax

Practice location:
  • Phone: 320-221-3820
  • Fax:
Mailing address:
  • Phone: 320-221-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1046104
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: