Provider Demographics
NPI:1730237322
Name:JONES, TIMOTHY ANDREW (MA, CCC-A)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:JONES
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2355 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8900
Mailing Address - Country:US
Mailing Address - Phone:505-325-7474
Mailing Address - Fax:505-326-4817
Practice Address - Street 1:2355 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8900
Practice Address - Country:US
Practice Address - Phone:505-325-7474
Practice Address - Fax:505-326-4817
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM754231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM97253Medicaid