Healthcare Provider Details

I. General information

NPI: 1679498885
Provider Name (Legal Business Name): KATLYN JORDACHE DBH, ED.S, MS, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 E UNIVERSITY DR STE 230
TEMPE AZ
85288-8402
US

IV. Provider business mailing address

225 CANAL ST UNIT 523
LEMONT IL
60439-3639
US

V. Phone/Fax

Practice location:
  • Phone: 480-613-4289
  • Fax:
Mailing address:
  • Phone: 480-613-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: