| Doctor Name: | JORDAN BERRY |
| NPI Number: | 1245528603 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AUD |
| License Number: | |
| Business Practice Address: | 9 N Water Street Ste 107 Sapulpa, OK - 74066 |
| Business Phone Number: | 9182245400 |
| Business Fax Number: | 9185126443 |
| Mailing Address: | 9 N Water St, Ste 107 SAPULPA |
| State: | OK |
| Postal Code: | 740662819 |
| Phone Number: | 9182245400 |
| Fax Number: | 9185126443 |
| NPI Enumeration Date: | 07/19/2011 |
| NPI Last Update Date: | 07/19/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |