MEDICARE: MRS. KATHERINE LISICIA JONES MED.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	SLP001414	GA

General Provider Information

NPI Number	:	1639472616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE LISICIA JONES MED.CCC-SLP

Provider Business Mailing Address
First Line	:	3230 NEW MAINE TRL
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-2882
Country	:	US
Telephone Number	:	678-513-6193
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 NEW MAINE TRL
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-2882
Country	:	US
Telephone Number	:	678-513-6193
Fax Number	:

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

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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