Provider Demographics
NPI:1902390115
Name:LOVE-ENRIQUEZ, JORDAN ADAIR (CCC-SLP, CBIS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ADAIR
Last Name:LOVE-ENRIQUEZ
Suffix:
Gender:F
Credentials:CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5923 W TONOPAH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6709
Mailing Address - Country:US
Mailing Address - Phone:253-722-7504
Mailing Address - Fax:
Practice Address - Street 1:14418 W MEEKER BLVD BLDG B
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5283
Practice Address - Country:US
Practice Address - Phone:623-888-3473
Practice Address - Fax:480-795-6157
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11136235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist