Healthcare Provider Details

I. General information

NPI: 1093627812
Provider Name (Legal Business Name): JORDAN MICHELLE ACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 E BELL RD
PHOENIX AZ
85022-2861
US

IV. Provider business mailing address

1814 E BELL RD APT 1042
PHOENIX AZ
85022-2865
US

V. Phone/Fax

Practice location:
  • Phone: 253-329-6742
  • Fax:
Mailing address:
  • Phone: 253-329-6742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number17880
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: