Provider Demographics
NPI:1720433709
Name:GIVENS, JORDAN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GIVENS
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 1:11711 MEMORIAL DR
Mailing Address - Street 2:555
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7255
Mailing Address - Country:US
Mailing Address - Phone:832-372-5441
Mailing Address - Fax:
Practice Address - Street 1:11711 MEMORIAL DR
Practice Address - Street 2:555
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7255
Practice Address - Country:US
Practice Address - Phone:832-372-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109299235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist