Healthcare Provider Details

I. General information

NPI: 1225593510
Provider Name (Legal Business Name): JORDAN ALEXANDRA FELL M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 LAMBETH ST
LOS ANGELES CA
90027-1410
US

IV. Provider business mailing address

3409 LAMBETH ST
LOS ANGELES CA
90027-1410
US

V. Phone/Fax

Practice location:
  • Phone: 847-636-1185
  • Fax:
Mailing address:
  • Phone: 847-636-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146012979
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: