Healthcare Provider Details

I. General information

NPI: 1609153790
Provider Name (Legal Business Name): JORDAN LEIGH FRASIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN LEIGH BAKER

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 RUSKIN DR
COLORADO SPRINGS CO
80910-2522
US

IV. Provider business mailing address

220 RUSKIN DR
COLORADO SPRINGS CO
80910-2522
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09924897
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: