Provider Demographics
NPI:1164820221
Name:STAEDTLER, JORDAN MARIE (MSED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:STAEDTLER
Suffix:
Gender:F
Credentials:MSED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 9TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2686
Mailing Address - Country:US
Mailing Address - Phone:605-394-4031
Mailing Address - Fax:
Practice Address - Street 1:625 9TH ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2686
Practice Address - Country:US
Practice Address - Phone:605-394-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-05
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist