Provider Demographics
NPI:1982453825
Name:WEESE, JORDAN MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHELLE
Last Name:WEESE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10260 US HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OK
Mailing Address - Zip Code:73051-9668
Mailing Address - Country:US
Mailing Address - Phone:580-339-2912
Mailing Address - Fax:
Practice Address - Street 1:1211 S 29TH ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-9651
Practice Address - Country:US
Practice Address - Phone:405-921-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist