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General NPI Number Information
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NPI Number | 1891344479
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Entity Type | Individual
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Provider Name | JORDYN MARIAH HOLMES
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Gender | Female
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Dates
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Enumeration Date | 09/06/2019
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Last Update Date | 01/26/2026
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Provider Practice Location Address
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Address Line | 2684 SW IMMANUEL DR
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City | PALM CITY
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State | FL
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Zip | 34990-2738
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Country | US
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Telephone | 772-291-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 NW FEDERAL HWY APT 1202
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City | STUART
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State | FL
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Zip | 34994-9388
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Country | US
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Telephone | 760-486-0010
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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 | SZ12313
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License Number State | FL
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