Healthcare Provider Details

I. General information

NPI: 1821679424
Provider Name (Legal Business Name): JORDAN LYNNE MARSHALL M.S CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631-3524
US

IV. Provider business mailing address

7129 W BELMONT AVE APT 202
CHICAGO IL
60634-5480
US

V. Phone/Fax

Practice location:
  • Phone: 773-644-7787
  • Fax:
Mailing address:
  • Phone: 309-221-1377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146016136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: