Provider Demographics
NPI:1962534198
Name:JORDON, KRISTEN ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELIZABETH
Last Name:JORDON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5019 W WILD BURRO SPRING DR
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-4289
Mailing Address - Country:US
Mailing Address - Phone:520-744-3792
Mailing Address - Fax:
Practice Address - Street 1:11279 W GRIER RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9609
Practice Address - Country:US
Practice Address - Phone:520-682-4782
Practice Address - Fax:520-682-4818
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP4463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist