Provider Demographics
NPI:1740840586
Name:KENT, JORDAN M (MS)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:M
Last Name:KENT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:M
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:4300 ROGERS AVE STE 20
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3152
Mailing Address - Country:US
Mailing Address - Phone:479-719-5736
Mailing Address - Fax:
Practice Address - Street 1:4300 ROGERS AVE STE 20
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3152
Practice Address - Country:US
Practice Address - Phone:479-719-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR200555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist