Healthcare Provider Details

I. General information

NPI: 1710216254
Provider Name (Legal Business Name): JANE C. JORDAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3022 STEINER ST
SAN FRANCISCO CA
94123-3908
US

IV. Provider business mailing address

3022 STEINER ST
SAN FRANCISCO CA
94123-3908
US

V. Phone/Fax

Practice location:
  • Phone: 415-931-5730
  • Fax: 415-931-5802
Mailing address:
  • Phone: 415-931-5730
  • Fax: 415-931-5802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberLCS5115
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS5115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: