Provider Demographics
NPI:1790100337
Name:TAYLOR-THREET, JORDAN (SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:TAYLOR-THREET
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 168
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74355-0168
Mailing Address - Country:US
Mailing Address - Phone:918-542-4101
Mailing Address - Fax:918-542-4410
Practice Address - Street 1:2225 N. MAIN ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354
Practice Address - Country:US
Practice Address - Phone:918-542-4101
Practice Address - Fax:918-542-4410
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4132235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist