Provider Demographics
NPI:1447701594
Name:JONES, SANDRA (ESA CERTIFICATE)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:ESA CERTIFICATE
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:PEMERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELOR OF ARTS
Mailing Address - Street 1:1265 SW PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-3624
Mailing Address - Country:US
Mailing Address - Phone:360-807-7245
Mailing Address - Fax:
Practice Address - Street 1:1265 SW PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3624
Practice Address - Country:US
Practice Address - Phone:360-807-7245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA337978A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist