Provider Demographics
NPI:1669037073
Name:DEVRIES, JORDAN N (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:N
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 STATE HIGHWAY DD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65706-1513
Mailing Address - Country:US
Mailing Address - Phone:417-859-2120
Mailing Address - Fax:
Practice Address - Street 1:170 STATE HIGHWAY DD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MO
Practice Address - Zip Code:65706-1513
Practice Address - Country:US
Practice Address - Phone:417-859-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024008280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist