Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 2853G | AL |
NPI | 1003167339 |
---|---|
Provider Name | Ashley Jordan |
First Address | Auburn, AL 36831-0871 |
Second Address | Auburn, AL 36830-4869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2012 |
Last Update Date | 19/07/2019 |