Provider Demographics
NPI:1952320723
Name:JORDAN, MELISSA ANN (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:MCNITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-A
Mailing Address - Street 1:2225 MAIN ST SW
Mailing Address - Street 2:STE 140
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9697
Mailing Address - Country:US
Mailing Address - Phone:616-942-1660
Mailing Address - Fax:616-942-5796
Practice Address - Street 1:1000 E PARIS AVE SE
Practice Address - Street 2:SUITE 230
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-3691
Practice Address - Country:US
Practice Address - Phone:616-942-1660
Practice Address - Fax:616-942-5796
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000154231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1952320723Medicaid
MIN71660014Medicare PIN