Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1043504665 |
---|---|
Provider Name | Wendy Jordan |
First Address | San Carlos, CA 94070-6221 |
Second Address | San Carlos, CA 94070-6221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2011 |
Last Update Date | 31/05/2011 |