Provider Demographics
NPI:1295216935
Name:WYNN, JORDYN TAYLOR (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JORDYN
Middle Name:TAYLOR
Last Name:WYNN
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 1:3210 ESPERANZA XING APT 5105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7815
Mailing Address - Country:US
Mailing Address - Phone:405-416-0646
Mailing Address - Fax:
Practice Address - Street 1:4105 TERAVISTA CLUB DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1525
Practice Address - Country:US
Practice Address - Phone:512-310-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist