Provider Demographics
NPI:1437661931
Name:JORDAN, KAYLA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 N HAMLIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7249
Mailing Address - Country:US
Mailing Address - Phone:773-217-8795
Mailing Address - Fax:
Practice Address - Street 1:2820 N HAMLIN AVE APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7249
Practice Address - Country:US
Practice Address - Phone:773-217-8795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146013906235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist