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General NPI Number Information
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NPI Number | 1801211388
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Entity Type | Individual
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Provider Name | MS. MARY EVE JORDAN
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Gender | Female
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 2024 ARKANSAS VALLEY DR SUITE 106
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City | LITTLE ROCK
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State | AR
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Zip | 72212-4166
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Country | US
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Telephone | 501-944-5968
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Fax |
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Provider Business Mailing Address
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Address Line | 21511 STONEWOOD LN
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City | ROLAND
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State | AR
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Zip | 72135-9373
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Country | US
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Telephone | 501-351-6395
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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 | SP#P8773
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License Number State | AR
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