Provider Demographics
NPI:1700596509
Name:CRAIGE, JORDAN SLOAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:SLOAN
Last Name:CRAIGE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:SLOAN
Other - Last Name:LINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:10407 US HIGHWAY 31 APT 417
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-7623
Mailing Address - Country:US
Mailing Address - Phone:251-721-3930
Mailing Address - Fax:
Practice Address - Street 1:8001 E FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-4811
Practice Address - Country:US
Practice Address - Phone:516-647-9954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP14104235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty