Provider Demographics
NPI:1184893356
Name:JORDAN, REBECCA PALMER (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:PALMER
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:ANNE
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC/SLP
Mailing Address - Street 1:410 NEW BRIDGE STREET SUITE 10-A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540
Mailing Address - Country:US
Mailing Address - Phone:910-347-2212
Mailing Address - Fax:910-347-6003
Practice Address - Street 1:410 NEW BRIDGE STREET SUITE 10-A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-347-2212
Practice Address - Fax:910-347-6003
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9157235Z00000X
NC8814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist