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General NPI Number Information
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NPI Number | 1437727682
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Entity Type | Individual
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Provider Name | MIRANDA LYNN JONESON AU.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 03/12/2022
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Provider Practice Location Address
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Address Line | 2201 SE LOOP 820 (126) AUDIOLOGY CLINIC
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City | FORT WORTH
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State | TX
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Zip | 76119
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Country | US
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Telephone | 817-730-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 SE LOOP 820 # FW126
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City | FORT WORTH
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State | TX
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Zip | 76119-5863
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Country | US
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Telephone | 309-339-8728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 12300971-4101
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License Number State | UT
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