Healthcare Provider Details

I. General information

NPI: 1205244357
Provider Name (Legal Business Name): JORDAN SIMON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 VARIEL AVE SUITE A
WOODLAND HILLS CA
91367-2514
US

IV. Provider business mailing address

6340 VARIEL AVE SUITE A
WOODLAND HILLS CA
91367-2514
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-4559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22923
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: