Healthcare Provider Details

I. General information

NPI: 1033708953
Provider Name (Legal Business Name): JORDAN GOPI NAGARURI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S HEWITT RD STE 100
YPSILANTI MI
48197-4594
US

IV. Provider business mailing address

850 S HEWITT RD STE 100
YPSILANTI MI
48197-4594
US

V. Phone/Fax

Practice location:
  • Phone: 734-544-5561
  • Fax: 734-527-5981
Mailing address:
  • Phone: 734-544-5561
  • Fax: 734-527-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009540
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: