Provider Demographics
NPI:1881275394
Name:CORSO, JORDAN L (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:L
Last Name:CORSO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:L
Other - Last Name:DIESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:19 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-6187
Mailing Address - Country:US
Mailing Address - Phone:724-554-1285
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6300
Practice Address - Country:US
Practice Address - Phone:304-243-8310
Practice Address - Fax:304-243-8430
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.14089235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist