MEDICARE: CRISTI JORDAN M.S. 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
1	235Z00000X	Speech-Language Pathologist	114125	TX

General Provider Information

NPI Number	:	1366227746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTI JORDAN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1520 DALLAS ST
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-4034
Country	:	US
Telephone Number	:	325-242-0133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 HICKORY ST
Second Line	:
City	:	COLORADO CITY
State	:	TX
Zip	:	79512-4912
Country	:	US
Telephone Number	:	325-242-9842
Fax Number	:	325-242-9899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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Directions to “ CRISTI JORDAN M.S. CCC-SLP” Practice Location

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