Provider Demographics
NPI:1851029318
Name:KORDES, BRANDI JO (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:JO
Last Name:KORDES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 GIESLER RD APT 8
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3648
Mailing Address - Country:US
Mailing Address - Phone:812-631-9238
Mailing Address - Fax:
Practice Address - Street 1:671 3RD AVE STE F
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3653
Practice Address - Country:US
Practice Address - Phone:812-630-2833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22007882A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist