Provider Demographics
NPI:1427814110
Name:MOLESKI, JORDYN ROSE
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:ROSE
Last Name:MOLESKI
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 1:400 N ROME AVE UNIT 1118
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-1249
Mailing Address - Country:US
Mailing Address - Phone:219-477-0881
Mailing Address - Fax:
Practice Address - Street 1:400 N ASHLEY DR UNIT 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4300
Practice Address - Country:US
Practice Address - Phone:813-775-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAI5462355A2700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology Assistant