Healthcare Provider Details

I. General information

NPI: 1659693109
Provider Name (Legal Business Name): JORDAN OWENS M.A. CCC-SLP, LBS-1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 W MADISON ST
CHICAGO IL
60602-4309
US

IV. Provider business mailing address

42 W MADISON ST
CHICAGO IL
60602-4309
US

V. Phone/Fax

Practice location:
  • Phone: 773-553-1000
  • Fax:
Mailing address:
  • Phone: 773-553-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242001483
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: