Healthcare Provider Details

I. General information

NPI: 1699224899
Provider Name (Legal Business Name): CASEY JORDEN MSW, SWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9143 VALMONT RD
BOULDER CO
80301-4819
US

IV. Provider business mailing address

4694 CHATHAM ST
BOULDER CO
80301-4032
US

V. Phone/Fax

Practice location:
  • Phone: 541-508-6080
  • Fax:
Mailing address:
  • Phone: 541-508-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier283234
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: