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General NPI Number Information
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NPI Number | 1578232104
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Entity Type | Individual
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Provider Name | JORDAN DANDREA
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Gender | Female
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 1260 WILLIAMS WAY
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City | YUBA CITY
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State | CA
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Zip | 95991-2400
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Country | US
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Telephone | 530-790-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 362 PLEASANT ST
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City | SOUTHINGTON
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State | CT
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Zip | 06489-2736
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Country | US
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Telephone | 860-919-8573
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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 | 006569
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License Number State | CT
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