Provider Demographics
NPI:1033708953
Name:GOPI NAGARURI, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GOPI NAGARURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S HEWITT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4594
Mailing Address - Country:US
Mailing Address - Phone:734-544-5561
Mailing Address - Fax:734-527-5981
Practice Address - Street 1:850 S HEWITT RD STE 100
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-4594
Practice Address - Country:US
Practice Address - Phone:734-544-5561
Practice Address - Fax:734-527-5981
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101009540235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist