MEDICARE: KRISTINA JORDAN M.A., CCC-SLP

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	013357-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013357-1	OTHER	NY	NEW YORK STATE LICENSE

General Provider Information

NPI Number	:	1235285420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA JORDAN M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	30 LITTLE EAST NECK RD S
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3208
Country	:	US
Telephone Number	:	631-288-1939
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 LITTLE EAST NECK RD S
Second Line	:
City	:	BABYLON
State	:	NY
Zip	:	11702-3208
Country	:	US
Telephone Number	:	631-288-1939
Fax Number	:

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/08/2007

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Directions to “ KRISTINA JORDAN M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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