Provider Demographics
NPI:1528534096
Name:ATKINS, JORDAN A (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3475 FALLING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-9084
Mailing Address - Country:US
Mailing Address - Phone:252-268-1247
Mailing Address - Fax:
Practice Address - Street 1:2401 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1727
Practice Address - Country:US
Practice Address - Phone:919-736-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1904164235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist