Provider Demographics
NPI:1942606025
Name:GORDEN, JENA (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:GORDEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 PAGE DR S
Mailing Address - Street 2:STE 101
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3551
Mailing Address - Country:US
Mailing Address - Phone:701-364-5433
Mailing Address - Fax:701-364-5431
Practice Address - Street 1:1720 UNIVERSITY DR S
Practice Address - Street 2:SANFORD HEALTH SPEECH PATHOLOGY
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-280-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND901235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist