Provider Demographics
NPI:1457522153
Name:PIEL, JORDAN S (MS)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:S
Last Name:PIEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LINDEN PL APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7815
Mailing Address - Country:US
Mailing Address - Phone:617-943-3780
Mailing Address - Fax:781-329-2207
Practice Address - Street 1:597 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1863
Practice Address - Country:US
Practice Address - Phone:781-329-2262
Practice Address - Fax:781-329-2207
Is Sole Proprietor?:No
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7398OtherMASS STATE LICENSE #