Provider Demographics
NPI:1174771356
Name:JONES, KATHLEEN (MS)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 BROOKFIELD CT
Mailing Address - Street 2:APT. E
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3923
Mailing Address - Country:US
Mailing Address - Phone:307-637-5130
Mailing Address - Fax:
Practice Address - Street 1:139 BROOKFIELD CT
Practice Address - Street 2:APT. E
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-3923
Practice Address - Country:US
Practice Address - Phone:307-637-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-30
Last Update Date:2008-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist