Provider Demographics
NPI:1902690498
Name:JORDAN, LACEY ANN (SLPA)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MENLO DR STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-3709
Mailing Address - Country:US
Mailing Address - Phone:916-287-1914
Mailing Address - Fax:
Practice Address - Street 1:575 MENLO DR STE 3
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3709
Practice Address - Country:US
Practice Address - Phone:916-287-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80542355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant