MEDICARE: JORDAN MARTIN

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	6142	SC
2	235Z00000X	Speech-Language Pathologist	11316	MD

General Provider Information

NPI Number	:	1437805231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MARTIN

Provider Business Mailing Address
First Line	:	112 JEAN DR
Second Line	:
City	:	EUTAWVILLE
State	:	SC
Zip	:	29048-9089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 BRUCEVILLE RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4671
Country	:	US
Telephone Number	:	843-425-7902
Fax Number	:

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

Provider Enumeration Date	:	03/01/2022
Last Update Date	:	04/20/2026

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Directions to “ JORDAN MARTIN ” Practice Location

Language	Start Address	Practice Location

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