Basic Information
| Provider Information | |||||||||
| NPI: | 1720210230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES-CALLICUTT | ||||||||
| FirstName: | QUASHEBA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA, CF-SLP | ||||||||
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| OtherLastName: | JONES | ||||||||
| OtherFirstName: | QUASHEBA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1034 | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | AR | ||||||||
| PostalCode: | 723641034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8707024911 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2424 DOUBLE CHURCHES RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063246112 | ||||||||
| FaxNumber: | 7065968259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | AR | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | SLP010783 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.