Provider Demographics
NPI:1902256480
Name:JONES, STACY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-1821
Mailing Address - Country:US
Mailing Address - Phone:405-275-1801
Mailing Address - Fax:866-347-6279
Practice Address - Street 1:1318 E INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-4137
Practice Address - Country:US
Practice Address - Phone:405-275-1801
Practice Address - Fax:866-347-6279
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist