Provider Demographics
NPI:1679862924
Name:JORDAN, MELANIE J (MASTER OF ARTS)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MASTER OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BONNIE BRAE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44473-9675
Mailing Address - Country:US
Mailing Address - Phone:330-856-4307
Mailing Address - Fax:
Practice Address - Street 1:211 REDONDO RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1805
Practice Address - Country:US
Practice Address - Phone:330-744-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-2430235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist