Individual
JACOB TYLER MORDHORST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CF-SLP
Contact information
Practice address
3706 MAPLE ST, OMAHA, NE 68111-3195
(402) 658-1083
Mailing address
3706 MAPLE ST, OMAHA, NE 68111-3195
(402) 658-1083
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
665
NE
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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