Provider Demographics
NPI:1427240514
Name:JORDAN, LESLIE FIEG (MCD, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:FIEG
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 SECLUDED GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447
Mailing Address - Country:US
Mailing Address - Phone:334-714-2692
Mailing Address - Fax:
Practice Address - Street 1:720 HEAVENS DR APT 22
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6702
Practice Address - Country:US
Practice Address - Phone:334-714-2692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
LA5817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist