Provider Demographics
NPI:1144062696
Name:JORDAN, CAROLINE CHRISTINE (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CHRISTINE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 COOPERS LANDING DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-6646
Mailing Address - Country:US
Mailing Address - Phone:269-276-6212
Mailing Address - Fax:
Practice Address - Street 1:395 S SHORE DR STE 310
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5466
Practice Address - Country:US
Practice Address - Phone:269-660-1025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101008580235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist