Healthcare Provider Details

I. General information

NPI: 1831030469
Provider Name (Legal Business Name): JORDAN UBERROTH MO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 N 18TH ST
SAINT JOSEPH MO
64501-1361
US

IV. Provider business mailing address

608 S WASHINGTON ST
OREGON MO
64473-9656
US

V. Phone/Fax

Practice location:
  • Phone: 816-671-4022
  • Fax:
Mailing address:
  • Phone: 816-808-8464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2025053456
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: