Healthcare Provider Details

I. General information

NPI: 1790100337
Provider Name (Legal Business Name): JORDAN THREET SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN TAYLOR SLP

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2203 S MAIN ST
GROVE OK
74344-5329
US

IV. Provider business mailing address

26660 S 620 RD
GROVE OK
74344-7407
US

V. Phone/Fax

Practice location:
  • Phone: 918-786-3797
  • Fax:
Mailing address:
  • Phone: 918-851-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4132
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: