Individual
JORDAN MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2400 47TH AVE S, GRAND FORKS, ND 58201
(701) 746-2205
(701) 787-4354
Mailing address
PO BOX 6000, GRAND FORKS, ND 58206-6000
(701) 746-2205
(701) 787-4354
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1618
ND
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1474088
—
ND
Enumeration date
02/01/2018
Last updated
03/25/2019
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