Healthcare Provider Details

I. General information

NPI: 1447957485
Provider Name (Legal Business Name): CAILYN J JORDAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2023
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date: 08/16/2024
Reactivation Date: 02/04/2025

III. Provider practice location address

7101 US HIGHWAY 90
DAPHNE AL
36526-9512
US

IV. Provider business mailing address

600 SUN TEMPLE DR
MADISON AL
35758-8643
US

V. Phone/Fax

Practice location:
  • Phone: 256-701-5651
  • Fax: 256-429-9411
Mailing address:
  • Phone: 256-288-3333
  • Fax: 256-288-3334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5888C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC11826
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: