Individual
DONNA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD, CCC-SLP
Contact information
Practice address
4241 SUMMERHILL RD, TEXARKANA, TX 75503-2733
(903) 794-3651
Mailing address
55 TIMBERLANE, TEXARKANA, TX 75501
(903) 824-0170
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
100202
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
065579701
—
TX
Enumeration date
08/15/2022
Last updated
08/15/2022
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