Provider Demographics
NPI:1578224564
Name:STROMBACK, JORDYN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:STROMBACK
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 1:3687 MT DIABLO BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3777
Mailing Address - Country:US
Mailing Address - Phone:925-954-4546
Mailing Address - Fax:925-415-6046
Practice Address - Street 1:3687 MT DIABLO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3777
Practice Address - Country:US
Practice Address - Phone:925-954-4546
Practice Address - Fax:925-415-6046
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist