Provider Demographics
NPI:1497328314
Name:JORDAN, LEIGH (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:JORDAN
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 1:5819 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-5494
Mailing Address - Country:US
Mailing Address - Phone:972-658-1774
Mailing Address - Fax:
Practice Address - Street 1:5819 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-5494
Practice Address - Country:US
Practice Address - Phone:972-658-1774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101584235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist