Provider Demographics
NPI:1659713980
Name:MAY, JORDAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELIZABETH
Last Name:MAY
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 1:48 SASSAFRAS DR
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:AR
Mailing Address - Zip Code:71753-4508
Mailing Address - Country:US
Mailing Address - Phone:903-824-4892
Mailing Address - Fax:
Practice Address - Street 1:506 E PINE ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:AR
Practice Address - Zip Code:71861-9496
Practice Address - Country:US
Practice Address - Phone:903-824-4892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377332355S0801X
AR2016482355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116506742Medicaid
TX021289601Medicaid
TX021289601Medicaid