Provider Demographics
NPI:1861207359
Name:BUNN, JORDAN BROOKE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:JORDAN
Middle Name:BROOKE
Last Name:BUNN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HIGHWAY 34 E STE A
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1325
Mailing Address - Country:US
Mailing Address - Phone:706-250-2281
Mailing Address - Fax:678-877-8066
Practice Address - Street 1:1601 HIGHWAY 34 E STE A
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1325
Practice Address - Country:US
Practice Address - Phone:706-250-2281
Practice Address - Fax:678-877-8066
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013437235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist