Provider Demographics
NPI:1629530324
Name:JORDAN, MINJA DOJCILOVIC (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MINJA
Middle Name:DOJCILOVIC
Last Name:JORDAN
Suffix:
Gender:F
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 1:10123 SWEETGRASS CIR UNIT 405
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-0899
Mailing Address - Country:US
Mailing Address - Phone:786-479-3940
Mailing Address - Fax:
Practice Address - Street 1:399 9TH ST N STE 102
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5820
Practice Address - Country:US
Practice Address - Phone:239-624-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL015078235Z00000X
FL18533235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty