MEDICARE: DEANNA JONES M.S., 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	1896	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	QMYPR0072409	OTHER	NM	MOLINA HEALTH CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10026765	OTHER	NM	LOVELACE HEALTH PLAN

General Provider Information

NPI Number	:	1104911148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA JONES M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4808 SAN TIMOTEO AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3833
Country	:	US
Telephone Number	:	505-328-0443
Fax Number	:	505-898-7378

Provider Business Practice Location Address
First Line	:	4808 SAN TIMOTEO AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-3833
Country	:	US
Telephone Number	:	505-328-0443
Fax Number	:	505-898-7378

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	06/04/2015

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