Provider Demographics
NPI:1548312531
Name:JORDAN, HEATHER DENISE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DENISE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WYATT LN
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9154
Mailing Address - Country:US
Mailing Address - Phone:336-977-6851
Mailing Address - Fax:336-384-4500
Practice Address - Street 1:247 WYATT LN
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9154
Practice Address - Country:US
Practice Address - Phone:336-977-6851
Practice Address - Fax:336-384-4500
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412327Medicaid