Provider Demographics
NPI:1659043040
Name:ROGERS, JORDAN DANIELLE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:DANIELLE
Last Name:ROGERS
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 1:1516 E PALM VALLEY BLVD BLDG C
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-4619
Mailing Address - Country:US
Mailing Address - Phone:512-733-2800
Mailing Address - Fax:512-300-5697
Practice Address - Street 1:1516 E PALM VALLEY BLVD BLDG C
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4619
Practice Address - Country:US
Practice Address - Phone:512-733-2800
Practice Address - Fax:512-300-5697
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR201599235Z00000X
TX121769235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist