Provider Demographics
NPI:1962180141
Name:KING, JORDAN R (AUD)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LINDLEY
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1780 W MCDERMOTT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3363
Mailing Address - Country:US
Mailing Address - Phone:972-733-3344
Mailing Address - Fax:972-733-3852
Practice Address - Street 1:1780 W MCDERMOTT DR STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3363
Practice Address - Country:US
Practice Address - Phone:972-733-3344
Practice Address - Fax:972-733-3852
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81643231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter