Provider Demographics
NPI:1942643341
Name:BISHOP, JORDAN CHRISTINE (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHRISTINE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4158 DEEP WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3522
Mailing Address - Country:US
Mailing Address - Phone:919-971-3315
Mailing Address - Fax:
Practice Address - Street 1:100 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5237
Practice Address - Country:US
Practice Address - Phone:919-484-0012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210649Medicaid