MEDICARE: JORDAN ELIZABETH MACNEIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3922	KS
2	235Z00000X	Speech-Language Pathologist	2023032457	MO

General Provider Information

NPI Number	:	1215712617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELIZABETH MACNEIL

Provider Business Mailing Address
First Line	:	1851 NW 38TH ST APT 307
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64116-4636
Country	:	US
Telephone Number	:	310-697-9703
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NE 108TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64156-6314
Country	:	US
Telephone Number	:	816-321-5020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/25/2023

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Directions to “ JORDAN ELIZABETH MACNEIL ” Practice Location

Language	Start Address	Practice Location

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