MEDICARE: LEXIE JORDON

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	106S00000X	Behavior Technician		MD

General Provider Information

NPI Number	:	1376405134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEXIE JORDON

Provider Business Mailing Address
First Line	:	PO BOX 360595
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-6595
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

Provider Business Practice Location Address
First Line	:	806 LANDMARK DR
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4980
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:	718-865-5165

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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Directions to “ LEXIE JORDON ” Practice Location

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