Provider Demographics
NPI:1356744924
Name:JORDAN, SARAH (MA, CCC-SLP, CBS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 OAK WOOD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2134
Mailing Address - Country:US
Mailing Address - Phone:202-212-8606
Mailing Address - Fax:
Practice Address - Street 1:36 OAK WOOD DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2134
Practice Address - Country:US
Practice Address - Phone:202-212-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-26
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024749235Z00000X
CT5031235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist