Provider Demographics
NPI:1669037073
Name:DEVRIES, JORDAN N (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:N
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4075 TIMBERLINE ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-6553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4075 TIMBERLINE ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-6553
Practice Address - Country:US
Practice Address - Phone:417-838-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2479235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist