Provider Demographics
NPI:1366003014
Name:JORDAN-MCCURDY, DEBRA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:JORDAN-MCCURDY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 SUMMERCREST LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2776
Mailing Address - Country:US
Mailing Address - Phone:478-454-8889
Mailing Address - Fax:678-280-6766
Practice Address - Street 1:2845 SUMMERCREST LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2776
Practice Address - Country:US
Practice Address - Phone:478-454-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008193235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJ635-172-65-721-0OtherDRIVERS LICENSE