Provider Demographics
NPI:1699847434
Name:JORDAN, SHERYL ANNE (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ANNE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 NW 23RD WAY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3601
Mailing Address - Country:US
Mailing Address - Phone:561-241-8747
Mailing Address - Fax:
Practice Address - Street 1:200 SE 19TH AVE
Practice Address - Street 2:BROWARD CHILDREN'S CENTER
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060
Practice Address - Country:US
Practice Address - Phone:954-943-9589
Practice Address - Fax:954-943-4115
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist