Provider Demographics
NPI:1487142188
Name:JONES, QUINTON D (SLP-CCC)
Entity type:Individual
Prefix:
First Name:QUINTON
Middle Name:D
Last Name:JONES
Suffix:
Gender:M
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 SHELLEY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-5031
Mailing Address - Country:US
Mailing Address - Phone:501-515-3299
Mailing Address - Fax:
Practice Address - Street 1:1410 W DAISY L GATSON BATES DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-5434
Practice Address - Country:US
Practice Address - Phone:501-313-5331
Practice Address - Fax:501-891-6195
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR215825795Medicaid