Provider Demographics
NPI:1629596507
Name:PARKER, JORDAN PAIGE (AUD)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAIGE
Last Name:PARKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KENT DR
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9043
Mailing Address - Country:US
Mailing Address - Phone:937-595-0366
Mailing Address - Fax:937-592-1002
Practice Address - Street 1:1970 N BECHTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1582
Practice Address - Country:US
Practice Address - Phone:937-772-4059
Practice Address - Fax:937-772-4142
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02109231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter