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General NPI Number Information
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NPI Number | 1164338190
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Entity Type | Individual
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Provider Name | JORDAN AALIYAH WOOTEN
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Gender | Female
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Dates
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Enumeration Date | 08/20/2026
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 1001 RESEARCH CENTER DR SW
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City | ATLANTA
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State | GA
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Zip | 30331
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Country | US
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Telephone | 404-691-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 3890 FLOYD RD APT 1307
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City | AUSTELL
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State | GA
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Zip | 30106-1520
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Country | US
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Telephone | 478-321-1408
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PCET004428
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License Number State | GA
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