Individual
MRS. JORDAN LESLIE SIEGALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1000 JOHNSON FERRY RD STE A100, MARIETTA, GA 30068-2110
(770) 977-9457
Mailing address
1000 JOHNSON FERRY RD STE A100, MARIETTA, GA 30068-2110
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007362
GA
235Z00000X
Speech-Language Pathologist
SZ 4809
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
545158891A
—
GA
Enumeration date
07/29/2009
Last updated
10/21/2010
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