Provider Demographics
NPI:1457543191
Name:JORDAN, CARLA J (MA, CFY-SLP, ATP)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, CFY-SLP, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JOHNSON LANE
Mailing Address - Street 2:CCSHNC BARBOURVILLE
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5330
Mailing Address - Country:US
Mailing Address - Phone:606-546-5109
Mailing Address - Fax:
Practice Address - Street 1:110 JOHNSON LANE
Practice Address - Street 2:CCSHNC BARBOURVILLE
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-5330
Practice Address - Country:US
Practice Address - Phone:606-546-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY07-063235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist