Healthcare Provider Details

I. General information

NPI: 1982580932
Provider Name (Legal Business Name): BROOKE REILLY JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N MARYLAND PKWY
LAS VEGAS NV
89101-3133
US

IV. Provider business mailing address

10819 MALTESE FALCON AVE
LAS VEGAS NV
89129-3234
US

V. Phone/Fax

Practice location:
  • Phone: 702-789-7282
  • Fax:
Mailing address:
  • Phone:
  • 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 NumberSP-4304
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: