Provider Demographics
NPI:1932681962
Name:WAKSER, JORDAN ILANA (BS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ILANA
Last Name:WAKSER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 E CHANDLER BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-6268
Mailing Address - Country:US
Mailing Address - Phone:480-710-8779
Mailing Address - Fax:480-718-7633
Practice Address - Street 1:1334 E CHANDLER BLVD STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-6268
Practice Address - Country:US
Practice Address - Phone:480-710-8779
Practice Address - Fax:480-718-7633
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA114572355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant