MEDICARE: JORDAN ASHLEY FROMSON

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

General Provider Information

NPI Number	:	1790208551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ASHLEY FROMSON

Provider Business Mailing Address
First Line	:	5000 S HIMES AVE APT 533
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33611-3660
Country	:	US
Telephone Number	:	860-634-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 PINEHURST DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5902
Country	:	US
Telephone Number	:	860-634-8044
Fax Number	:

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

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	11/10/2020

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