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NPI Code Detail

MEDICARE: JORDAN TAYLOR EASTERLIN

MEDICARE: JORDAN TAYLOR EASTERLIN
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1780496935
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN TAYLOR EASTERLIN
Provider Business Mailing Address
First Line : 5231 W PRINCETON DR
Second Line :
City : FRANKLIN
State : WI
Zip : 53132-9425
Country : US
Telephone Number : 414-331-2781
Fax Number :
Provider Business Practice Location Address
First Line : 1250 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2225
Country : US
Telephone Number : 800-222-6544
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2025
Last Update Date : 09/22/2025

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Directions to “ JORDAN TAYLOR EASTERLIN ” Practice Location

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