Provider Demographics
NPI:1497590186
Name:TIJERINA, JORDAN N
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 KNIGHT LAKE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7984
Mailing Address - Country:US
Mailing Address - Phone:832-748-1874
Mailing Address - Fax:
Practice Address - Street 1:12710 RESEARCH BLVD STE 395
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4397
Practice Address - Country:US
Practice Address - Phone:512-250-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist