Healthcare Provider Details

I. General information

NPI: 1154252005
Provider Name (Legal Business Name): JORDAN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W HOWARD ST
CHICAGO IL
60645-1228
US

IV. Provider business mailing address

514 DEER TRAIL RD
CHICAGO HEIGHTS IL
60411-1604
US

V. Phone/Fax

Practice location:
  • Phone: 773-305-6400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: