=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831060797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAVYN JONES SLPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2025
-----------------------------------------------------
Last Update Date | 09/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7205 S POWER RD
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142-7456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-456-0232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6753 S RUSSET SKY WAY
-----------------------------------------------------
City | GOLD CANYON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85118-2949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-456-0232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | SLPA16770
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------