Provider Demographics
NPI:1083122022
Name:SANTOS, JORDAN MARIE
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:MARIE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:MARIE
Other - Last Name:CELAYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7300 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2941
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1625 STOCKTON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7098
Practice Address - Country:US
Practice Address - Phone:916-262-9040
Practice Address - Fax:916-262-9043
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist