Provider Demographics
NPI:1922853472
Name:SCHROEDER, JORDAN MARIE
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:MARIE
Other - Last Name:BERNHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1422 TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-5758
Mailing Address - Country:US
Mailing Address - Phone:928-830-8834
Mailing Address - Fax:
Practice Address - Street 1:3160 STILLWATER DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7151
Practice Address - Country:US
Practice Address - Phone:928-776-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA-125602355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant