Healthcare Provider Details

I. General information

NPI: 1801735154
Provider Name (Legal Business Name): JORDAN MAMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 MORSE AVE
SUNNYVALE CA
94085-3010
US

IV. Provider business mailing address

2669 CASCO CT
SAN JOSE CA
95121-2808
US

V. Phone/Fax

Practice location:
  • Phone: 669-454-3163
  • Fax:
Mailing address:
  • Phone: 408-643-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: