Provider Demographics
NPI:1689868655
Name:JORDAN, KRYSTAL LORI (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:LORI
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MISS
Other - First Name:KRYSTAL
Other - Middle Name:LORI
Other - Last Name:SCHUBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD, CF-SLP
Mailing Address - Street 1:4405 STONEY DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9571
Mailing Address - Country:US
Mailing Address - Phone:870-219-5534
Mailing Address - Fax:
Practice Address - Street 1:3423 E HIGHLAND DR
Practice Address - Street 2:STE. A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6404
Practice Address - Country:US
Practice Address - Phone:870-336-0021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP8032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist