Individual
JORDAN RENEA BOSWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 WESTLAND ST, SAN ANGELO, TX 76901-3051
(325) 340-4025
Mailing address
105 WESTLAND AVE, SAN ANGELO, TX 76901
(325) 340-4020
(325) 617-7809
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
38874
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38874
SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY LICENSE
TX
Enumeration date
09/07/2016
Last updated
09/07/2016
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