MEDICARE: MISS JORDAN BROOKE BUNN 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	SLP013437	GA

General Provider Information

NPI Number	:	1861207359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JORDAN BROOKE BUNN CCC-SLP

Provider Business Mailing Address
First Line	:	1601 HIGHWAY 34 E STE A
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-1325
Country	:	US
Telephone Number	:	706-250-2281
Fax Number	:	678-877-8066

Provider Business Practice Location Address
First Line	:	1601 HIGHWAY 34 E STE A
Second Line	:
City	:	NEWNAN
State	:	GA
Zip	:	30265-1325
Country	:	US
Telephone Number	:	706-250-2281
Fax Number	:	678-877-8066

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

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	04/06/2026

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Directions to “ MISS JORDAN BROOKE BUNN CCC-SLP” Practice Location

Language	Start Address	Practice Location

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