Jordan Johnson, M. ED CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Fox Point, WI
NPI 1710399423 · NPPES record last updated May 6, 2024
Key facts
- NPI
- 1710399423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- Practice address
- 8221 N Mohawk Rd
Fox Point, WI 53217-2725 - Phone
- (815) 871-9570
- NPI assigned
- May 29, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230509001980 | WI | Practitioner - Qualified Speech Language Pathologist | 3072979475 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Education
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paxxon Healthcare Services LLC | Speech-Language Pathologist | Current |
Accepting new patients |
| Paxxon Healthcare Services LLC | Current |
Accepting new patients |
Locations
2210 Dufek Dr
Manitowoc, WI 54220
Phone (715) 574-4724
1111 E Capitol Dr
Shorewood, WI 53211
Phone (262) 293-3207
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Yes |
Addresses
Primary practice location
8221 N Mohawk Rd
Fox Point, WI 53217-2725
Mailing address
1905 N Water St Apt 305
Milwaukee, WI 53202-1589
Other practice location 1
2448 S 102nd St
Suite 340
Milwaukee, WI 53227-2466
Phone (414) 329-2500
Other providers in Fox Point, WI
- Adam Kenneth Heinze
- Stephen D Hughes
- Michelle Hwang
- Integra Physical Therapy,SC
- Margaret Rose Jacoby
- Juliette Martin-Thomas PHD SC
- Kaleidoscope Therapies, LLC
- Michael Karegeannes
- Manous Karimi
- Ellen M Kay
All providers in Fox Point, WI · Speech-Language Pathologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.