Provider Demographics
NPI:1609484211
Name:STEVENS, JORDYN SARAH
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:SARAH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 WINDING RIDGE DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7551
Mailing Address - Country:US
Mailing Address - Phone:989-745-4701
Mailing Address - Fax:
Practice Address - Street 1:1309 WINDING RIDGE DR APT 2B
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7551
Practice Address - Country:US
Practice Address - Phone:989-745-4701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7151001737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist