Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 7650 | NE |
Y | 225XM0800X | Mental Health | 12728 | NE |
NPI | 1811663925 |
---|---|
Provider Name | Madison Bayley Jordan |
First Address | Council Bluffs, IA 51501-3764 |
Second Address | Omaha, NE 68127-3214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2021 |
Last Update Date | 18/08/2021 |