MEDICARE: IVY NICOLE JONES 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	2024021825	MO

General Provider Information

NPI Number	:	1447083795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY NICOLE JONES SLP

Provider Business Mailing Address
First Line	:	166 AMERICAN INN RD
Second Line	:
City	:	VILLA RIDGE
State	:	MO
Zip	:	63089-2152
Country	:	US
Telephone Number	:	636-649-8275
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 GRAND AVE
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-1209
Country	:	US
Telephone Number	:	636-239-9190
Fax Number	:

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

Provider Enumeration Date	:	08/22/2024
Last Update Date	:	08/22/2024

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Directions to “ IVY NICOLE JONES SLP” Practice Location

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