Provider Demographics
NPI:1245964576
Name:HAAS, JORDAN CHARLINE (MS, SLP -CF)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHARLINE
Last Name:HAAS
Suffix:
Gender:F
Credentials:MS, SLP -CF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 S COLT DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-7341
Mailing Address - Country:US
Mailing Address - Phone:480-202-1309
Mailing Address - Fax:
Practice Address - Street 1:3443 E CALISTOGA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-8024
Practice Address - Country:US
Practice Address - Phone:480-297-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP13816235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist