Healthcare Provider Details

I. General information

NPI: 1164098562
Provider Name (Legal Business Name): COURTNEY JORDAN SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SCHOOL ST STE 2
MILBRIDGE ME
04658-3542
US

IV. Provider business mailing address

598 N BEND RD
SURRY ME
04684-3322
US

V. Phone/Fax

Practice location:
  • Phone: 207-546-2880
  • Fax:
Mailing address:
  • Phone: 207-479-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSAS3441
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: