Provider Demographics
NPI:1962701086
Name:JORDAN, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:492 HIGHWAY 25 N
Mailing Address - Street 2:
Mailing Address - City:GUY
Mailing Address - State:AR
Mailing Address - Zip Code:72061-7800
Mailing Address - Country:US
Mailing Address - Phone:501-679-3509
Mailing Address - Fax:501-679-3508
Practice Address - Street 1:492 HIGHWAY 25 N
Practice Address - Street 2:
Practice Address - City:GUY
Practice Address - State:AR
Practice Address - Zip Code:72061-7800
Practice Address - Country:US
Practice Address - Phone:501-679-3509
Practice Address - Fax:501-679-3508
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP3218235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist