Provider Demographics
NPI:1851900039
Name:LIN, JORDAN WHITLOCK (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:WHITLOCK
Last Name:LIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ASHLEY
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:240 SIDNEY ST UNIT 106
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4298
Mailing Address - Country:US
Mailing Address - Phone:339-222-9774
Mailing Address - Fax:
Practice Address - Street 1:240 SIDNEY ST UNIT 106
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4298
Practice Address - Country:US
Practice Address - Phone:339-222-9774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111797235Z00000X
MA9633235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist