Provider Demographics
NPI:1194340927
Name:FERNEKEES, JORDAN DANA (CF-SLP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:DANA
Last Name:FERNEKEES
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S RED HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-6483
Mailing Address - Country:US
Mailing Address - Phone:302-674-3350
Mailing Address - Fax:928-752-3350
Practice Address - Street 1:541 S RED HAVEN LN
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-6483
Practice Address - Country:US
Practice Address - Phone:302-674-3350
Practice Address - Fax:928-752-3350
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEO4-0000666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist