Provider Demographics
NPI:1659693109
Name:OWENS, JORDAN (MA CCC-SLP, LBS-1)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:MA CCC-SLP, LBS-1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4309
Mailing Address - Country:US
Mailing Address - Phone:773-553-1000
Mailing Address - Fax:
Practice Address - Street 1:42 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4309
Practice Address - Country:US
Practice Address - Phone:773-553-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL242001483235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL897511OtherISBE