Provider Demographics
NPI:1609563840
Name:HENDRIX, JORDAN GABRIELLE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:GABRIELLE
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 OLD ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2409
Mailing Address - Country:US
Mailing Address - Phone:334-312-2387
Mailing Address - Fax:
Practice Address - Street 1:7112 UNIVERSITY CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8045
Practice Address - Country:US
Practice Address - Phone:334-612-7176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5344235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist