Provider Demographics
NPI:1861190266
Name:ROACH, JORDAN ELAINE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELAINE
Last Name:ROACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13216 VILLAGE TRACE DR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-6145
Mailing Address - Country:US
Mailing Address - Phone:985-264-8438
Mailing Address - Fax:
Practice Address - Street 1:35614 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-5840
Practice Address - Country:US
Practice Address - Phone:985-641-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA92492355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant