Provider Demographics
NPI:1043989627
Name:WALSH, JORDAN C (MS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:C
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DEN MAR DR
Mailing Address - Street 2:
Mailing Address - City:HOLTWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:17532-9621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 S KINZER AVE
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-8736
Practice Address - Country:US
Practice Address - Phone:717-355-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSL001525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist