Healthcare Provider Details

I. General information

NPI: 1093798589
Provider Name (Legal Business Name): ROSEMARY JORDAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date: 02/01/2006
Reactivation Date: 03/27/2006

III. Provider practice location address

2100 52ND AVE
MOLINE IL
61265-6366
US

IV. Provider business mailing address

1523 S BLUFF BLVD
CLINTON IA
52732-6549
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-2900
  • Fax: 309-797-2417
Mailing address:
  • Phone: 563-243-6054
  • Fax: 563-243-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149008968
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: