MEDICARE: ANGELA JORDAN MA, 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	SL009896	PA

General Provider Information

NPI Number	:	1841799475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA JORDAN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	757 GARLOW BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15239-1109
Country	:	US
Telephone Number	:	919-368-2815
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SIBERIAN AVE
Second Line	:
City	:	LEECHBURG
State	:	PA
Zip	:	15656-1278
Country	:	US
Telephone Number	:	919-368-2815
Fax Number	:	919-368-2815

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

Provider Enumeration Date	:	02/09/2018
Last Update Date	:	02/09/2018

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