Provider Demographics
NPI:1538729967
Name:PICKETT, JORDAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KINCAID RD
Mailing Address - Street 2:
Mailing Address - City:MINOR HILL
Mailing Address - State:TN
Mailing Address - Zip Code:38473-5300
Mailing Address - Country:US
Mailing Address - Phone:931-638-7235
Mailing Address - Fax:
Practice Address - Street 1:2976 S XANTHIA CT
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4239
Practice Address - Country:US
Practice Address - Phone:931-638-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6180235Z00000X
COSLP.0005278235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist