Provider Demographics
NPI:1538204284
Name:JONES, WYLANTA RENE (SLP)
Entity type:Individual
Prefix:
First Name:WYLANTA
Middle Name:RENE
Last Name:JONES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:WYLANTA
Other - Middle Name:RENE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14050 S HWY 69
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:AZ
Mailing Address - Zip Code:86333
Mailing Address - Country:US
Mailing Address - Phone:623-326-2150
Mailing Address - Fax:
Practice Address - Street 1:HUMBOLDT UNIFIED SCHOOL DISTRICT #22 SPECIAL SRVCS OFIC
Practice Address - Street 2:8766 EAST HWY 69
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4028
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP2190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ759277Medicaid