Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | S.0700966 | OH |
NPI | 1003111949 |
---|---|
Provider Name | Jasmine G Jordan |
First Address | Pepper Pike, OH 44124-5712 |
Second Address | Pepper Pike, OH 44124-5712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2011 |
Last Update Date | 25/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0268768 | (05) | OH |