Provider Demographics
NPI:1447083795
Name:JONES, IVY NICOLE (SLP)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:NICOLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:166 AMERICAN INN RD
Mailing Address - Street 2:
Mailing Address - City:VILLA RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63089-2152
Mailing Address - Country:US
Mailing Address - Phone:636-649-8275
Mailing Address - Fax:
Practice Address - Street 1:201 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-1209
Practice Address - Country:US
Practice Address - Phone:636-239-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024021825235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist