Provider Demographics
NPI:1912517061
Name:BERARDI, JORDAN MARIE (MHS, CCC-SLP, CLE)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:BERARDI
Suffix:
Gender:F
Credentials:MHS, CCC-SLP, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 194TH ST SW UNIT 108
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5249
Mailing Address - Country:US
Mailing Address - Phone:816-645-6096
Mailing Address - Fax:
Practice Address - Street 1:7272 W MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-4140
Practice Address - Country:US
Practice Address - Phone:206-305-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI61072849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist