Provider Demographics
NPI:1760125462
Name:JORDAN, ELLA PERRY (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:PERRY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-6648
Mailing Address - Country:US
Mailing Address - Phone:252-531-4141
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST STE 231N
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5204
Practice Address - Country:US
Practice Address - Phone:919-610-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist