Healthcare Provider Details

I. General information

NPI: 1649548108
Provider Name (Legal Business Name): JORDAN RIORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2011
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 E LIBERTY LN
GILBERT AZ
85296
US

IV. Provider business mailing address

3462 E LIBERTY LN
GILBERT AZ
85296-7362
US

V. Phone/Fax

Practice location:
  • Phone: 480-748-8167
  • Fax:
Mailing address:
  • Phone: 480-748-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA7550
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP7550
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP7550
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: