MEDICARE: JORDAN C MCNEELY PC

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	101YP2500X	Professional Counselor	C.1200540	OH

General Provider Information

NPI Number	:	1598193195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN C MCNEELY PC

Provider Business Mailing Address
First Line	:	3952 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3521
Country	:	US
Telephone Number	:	513-661-8336
Fax Number	:	513-661-8111

Provider Business Practice Location Address
First Line	:	3952 N BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3521
Country	:	US
Telephone Number	:	513-661-8336
Fax Number	:	513-661-8111

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

Provider Enumeration Date	:	10/17/2013
Last Update Date	:	10/17/2013

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