Provider Demographics
NPI:1306203021
Name:MESSERSMITH, JORDON PETER EUGENE (MSED SLP)
Entity Type:Individual
Prefix:MR
First Name:JORDON
Middle Name:PETER EUGENE
Last Name:MESSERSMITH
Suffix:
Gender:M
Credentials:MSED SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N TYLER ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1744
Mailing Address - Country:US
Mailing Address - Phone:402-469-9827
Mailing Address - Fax:
Practice Address - Street 1:1104 N TYLER ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1744
Practice Address - Country:US
Practice Address - Phone:402-469-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE503235Z00000X
NE1963235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist