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General NPI Number Information
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NPI Number | 1710734470
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Entity Type | Individual
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Provider Name | JORDAN RUDD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2024
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 11330 LEGACY DR STE 306
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City | FRISCO
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State | TX
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Zip | 75033-1217
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Country | US
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Telephone | 469-297-6340
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Fax |
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Provider Business Mailing Address
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Address Line | 1708 KITTYHAWK DR
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City | LITTLE ELM
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State | TX
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Zip | 75068-8482
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Country | US
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Telephone |
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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 | 120872
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License Number State | TX
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