MEDICARE: JEFFREY EDWARD JORDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	187177	OH

General Provider Information

NPI Number	:	1295597623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY EDWARD JORDAN

Provider Business Mailing Address
First Line	:	3342 E 137TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-3902
Country	:	US
Telephone Number	:	216-338-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	3342 E 137TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-3902
Country	:	US
Telephone Number	:	216-338-2061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2024
Last Update Date	:	01/30/2024

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Directions to “ JEFFREY EDWARD JORDAN ” Practice Location

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