Provider Demographics
NPI:1295417517
Name:GUARDIOLA, JORDYN ASHLEY (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:JORDYN
Middle Name:ASHLEY
Last Name:GUARDIOLA
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 1:3330 EASTPARK BLVD APT 1215
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1550
Mailing Address - Country:US
Mailing Address - Phone:254-495-9677
Mailing Address - Fax:
Practice Address - Street 1:304 N 3RD ST
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-5181
Practice Address - Country:US
Practice Address - Phone:940-482-2604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist