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NPI Code Detail

MEDICARE: JORDAN WALLS MS CCC-SLP

MEDICARE: JORDAN WALLS MS 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
1235Z00000XSpeech-Language PathologistSA17436FL

General Provider Information

NPI Number : 1720622525
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN WALLS MS CCC-SLP
Provider Business Mailing Address
First Line : 1240 MARBELLA PLAZA DR
Second Line :
City : TAMPA
State : FL
Zip : 33619-7906
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1240 MARBELLA PLAZA DR
Second Line :
City : TAMPA
State : FL
Zip : 33619-7906
Country : US
Telephone Number : 813-341-2726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2019
Last Update Date : 11/05/2019

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Directions to “ JORDAN WALLS MS CCC-SLP” Practice Location

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