Provider Demographics
NPI:1457470304
Name:JORDAN, ANGELA LEE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:LEE
Last Name:JORDAN
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 1:227 KENILWORTH DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6765
Mailing Address - Country:US
Mailing Address - Phone:330-836-6685
Mailing Address - Fax:
Practice Address - Street 1:2101 FRONT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3251
Practice Address - Country:US
Practice Address - Phone:888-923-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-7463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist