Provider Demographics
NPI:1346857562
Name:FETGATTER, JORDAN ALYSSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALYSSA
Last Name:FETGATTER
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 1:2814 PARKSIDE VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7258
Mailing Address - Country:US
Mailing Address - Phone:713-553-0265
Mailing Address - Fax:
Practice Address - Street 1:10800 FLORA MAE MEADOWS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-5974
Practice Address - Country:US
Practice Address - Phone:832-328-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114716235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist