Provider Demographics
NPI:1730336629
Name:FJORDBAK, BESS SIRMON (PHD, CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:BESS
Middle Name:SIRMON
Last Name:FJORDBAK
Suffix:
Gender:F
Credentials:PHD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 N STANTON ST
Mailing Address - Street 2:#176
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1238
Mailing Address - Country:US
Mailing Address - Phone:915-202-7271
Mailing Address - Fax:
Practice Address - Street 1:4800 N STANTON ST
Practice Address - Street 2:#176
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1238
Practice Address - Country:US
Practice Address - Phone:915-202-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102632235Z00000X
GA1573235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist