Provider Demographics
NPI:1851809966
Name:DORDAN, MAKAYLA MARIE (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:MARIE
Last Name:DORDAN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE CHILDREN'S PLACE
Mailing Address - Street 2:MS: 90-49-023
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1081
Mailing Address - Country:US
Mailing Address - Phone:314-454-6171
Mailing Address - Fax:
Practice Address - Street 1:ONE CHILDREN'S PLACE
Practice Address - Street 2:MS: 90-49-023
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1081
Practice Address - Country:US
Practice Address - Phone:314-454-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician