Healthcare Provider Details

I. General information

NPI: 1467695791
Provider Name (Legal Business Name): SELENA JORDAN M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 05/23/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2918 ALANWOOD CT
SPRING VALLEY CA
91978-1974
US

IV. Provider business mailing address

2918 ALANWOOD CT
SPRING VALLEY CA
91978-1974
US

V. Phone/Fax

Practice location:
  • Phone: 619-944-2926
  • Fax:
Mailing address:
  • Phone: 619-944-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA #1084479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: