MEDICARE: MARY BETH JONES MS CCC SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1093989378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BETH JONES MS CCC SLP

Provider Business Mailing Address
First Line	:	5608 DEBLYN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2606
Country	:	US
Telephone Number	:
Fax Number	:	808-242-4762

Provider Business Practice Location Address
First Line	:	5608 DEBLYN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-2606
Country	:	US
Telephone Number	:	808-264-3825
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	05/02/2018

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