Provider Demographics
NPI:1598416075
Name:SCHACHTER, JORDAN R (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:R
Last Name:SCHACHTER
Suffix:
Gender:M
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 1:504B W ALISO ST
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2508
Mailing Address - Country:US
Mailing Address - Phone:805-836-9729
Mailing Address - Fax:
Practice Address - Street 1:504B W ALISO ST
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2508
Practice Address - Country:US
Practice Address - Phone:805-836-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14256899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty