Provider Demographics
NPI:1013408798
Name:RUSSELL, JOURDON H (SLP)
Entity Type:Individual
Prefix:
First Name:JOURDON
Middle Name:H
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 GROGANS MILL RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3666
Mailing Address - Country:US
Mailing Address - Phone:832-616-3075
Mailing Address - Fax:
Practice Address - Street 1:9450 GROGANS MILL RD STE 150
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3666
Practice Address - Country:US
Practice Address - Phone:832-616-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4422235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist