Provider Information for 1144714767
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REBECCA DIANE JORDAN LCSW
Sex: Female
NPI: 1144714767
Last Updated: 2023-07-14
Certification Date: 2023-07-10
Certification Date: 2023-07-10
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1144714767 | ||||||||||||
| Enumeration Date | 2018-06-18 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 478-200 HIGHWAY 139 SUSANVILLE, CA 96130 United States Phone: 530-251-8836 | Fax: | ||||||||||||
| Primary Practice Address | 478-200 HIGHWAY 139 SUSANVILLE, CA 96130 United States Phone: 530-251-8836 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 555 HOSPITAL LN | ||||||||||||
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