Organization
CARMEN S JORDAN
Active
Other names
Core Speech Pathology Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CARMEN S JORDAN CCC-SLP (OWNER)
(815) 978-5181
Entity
Organization
Contact information
Practice address
1102 18TH ST, ROCKFORD, IL 61104-3422
(815) 978-5181
Mailing address
1102 18TH ST, ROCKFORD, IL 61104-3422
(815) 978-5181
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146.007060
IL
252Y00000X
Early Intervention Provider Agency
CJ05640701P
IL
Other
Enumeration date
03/02/2012
Last updated
03/02/2012
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