Provider Demographics
NPI:1144583162
Name:JORDAN, SHALON MARIE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHALON
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 PICA AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-2064
Mailing Address - Country:US
Mailing Address - Phone:432-559-7451
Mailing Address - Fax:
Practice Address - Street 1:8700 PICA AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-2064
Practice Address - Country:US
Practice Address - Phone:432-559-7451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist