Provider Demographics
NPI:1497386627
Name:HAZELRIG, JORDYN R (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:R
Last Name:HAZELRIG
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:R
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:334 BROOKWOOD DR W
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-7405
Mailing Address - Country:US
Mailing Address - Phone:616-443-9598
Mailing Address - Fax:
Practice Address - Street 1:7985 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506-6427
Practice Address - Country:US
Practice Address - Phone:770-781-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009959235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003230074AMedicaid