Provider Demographics
NPI:1801211388
Name:JORDAN, MARY EVE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:EVE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21511 STONEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9373
Mailing Address - Country:US
Mailing Address - Phone:501-351-6395
Mailing Address - Fax:
Practice Address - Street 1:2024 ARKANSAS VALLEY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-4166
Practice Address - Country:US
Practice Address - Phone:501-944-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist