Jordan Portner

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

242006237 Issued in IL

Practice address

634 N Main St Ste 3
O Fallon, IL 62269-3746

Phone

(618) 632-4222

NPI assigned

Jan 28, 2022

Last updated

Feb 9, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Abc Pediatric Therapy, LLC

  • Speech-Language Pathologist
  • O'Fallon, IL
  • NPI 1124044698
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644364800000",
    "number": "1346993573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 N MAIN ST STE 3",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693746",
            "telephone_number": "618-632-4222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 N MAIN ST STE 3",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693746",
            "telephone_number": "618-632-4222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTNER",
        "first_name": "JORDAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-28",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242006237",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "242.006237",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aurelia Popp
• Kimberly Elise Portale, D.O.
• Rece Portell, PA
• Amy Jean Porter, MS, CCC-SLP/L
• Shayla Porter, RBT
• Caitlin Elizabeth Poths, RBT
• Ryan Sean Potts, B.S RBT
• Powerback Rehabilitation LLC (Powerback Rehabilitation)
• Powerback Rehabilitation LLC (Powerback Rehabilitation)
• Tara McKay Powers

• Speech-Language Pathologist in O'Fallon, IL
• Providers in O'Fallon, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.