Provider Information for 1134687890
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JENNIFER JORDAN LCSW
Sex: Female
NPI: 1134687890
Last Updated: 2024-07-26
Certification Date: 2024-07-26
Certification Date: 2024-07-26
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134687890 | ||||||||
| Enumeration Date | 2019-03-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 81 DRAGON FLY DR BETHEL, ME 04217-3064 United States Phone: 207-381-7101 | Fax: | ||||||||
| Primary Practice Address | 81 DRAGON FLY DR BETHEL, ME 04217-3064 United States Phone: 207-381-7101 | Fax: | ||||||||
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