Provider Demographics
NPI:1215583992
Name:PIES, JORDAN RAE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:RAE
Last Name:PIES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 HILLMEADE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2259
Mailing Address - Country:US
Mailing Address - Phone:513-739-2189
Mailing Address - Fax:
Practice Address - Street 1:1273 NORTHFIELD DR STE 3
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6184
Practice Address - Country:US
Practice Address - Phone:931-553-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6535235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist