Mary Grace Jaques, M.ED., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP010476 Issued in NU

Practice address

40 Professional Dr
Jefferson, GA 30549-6333

Phone

(114) 170-6367

NPI assigned

May 22, 2019

Last updated

May 22, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558483200000",
    "number": "1710544119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 BALDWIN ST APT 14",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306055152",
            "telephone_number": "706-399-1865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 PROFESSIONAL DR",
            "city": "JEFFERSON",
            "state": "GA",
            "postal_code": "305496333",
            "telephone_number": "114-170-6367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "280 Gaines School Rd",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306053156",
            "country_code": "US",
            "telephone_number": "706-548-7296 x29416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAQUES",
        "first_name": "MARY",
        "middle_name": "GRACE",
        "credential": "M.ED., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": "SLP010476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jackson County Health Department
• Jackson County School System
• Jackson County Senior Center
• Emma A James, MS, OTR/L
• Jyotir Jani, M.D.
• Jefferson City Schools
• Jefferson Counseling, LLC
• Jefferson Drug Company, Inc.
• Jefferson Pain Clinic Inc
• Jefferson Pediatrics, Inc.

• Speech-Language Pathologist in Jefferson, GA
• Providers in Jefferson, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.