Individual
JORDAN DIVILBISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., CCC-SLP
Contact information
Practice address
14715 BRISTOL PARK BLVD, EDMOND, OK 73013-1894
(405) 840-1686
(405) 840-1006
Mailing address
14715 BRISTOL PARK BLVD, EDMOND, OK 73013-1894
(405) 840-1686
(405) 840-1006
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4323
OK
Other
Enumeration date
01/05/2015
Last updated
01/05/2015
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