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NPI Code Detail

MEDICARE: JORDAN CANNON MSP CCC-SLP

MEDICARE: JORDAN CANNON MSP CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist11536NC
2235Z00000XSpeech-Language Pathologist5997SC

General Provider Information

NPI Number : 1134528359
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN CANNON MSP CCC-SLP
Provider Business Mailing Address
First Line : 6740 EVANTON LOCH RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28278-8010
Country : US
Telephone Number : 219-608-4219
Fax Number :
Provider Business Practice Location Address
First Line : 3241 NEW RENAISSANCE WAY
Second Line :
City : CHARLOTTE
State : NC
Zip : 28208-6633
Country : US
Telephone Number : 980-343-0049
Fax Number : 980-343-0053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2014
Last Update Date : 06/11/2026

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Directions to “ JORDAN CANNON MSP CCC-SLP” Practice Location

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