Healthcare Provider Details

I. General information

NPI: 1386502029
Provider Name (Legal Business Name): TON'NI JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15507 S ROUTE 59 STE 107E
PLAINFIELD IL
60544-2723
US

IV. Provider business mailing address

519 LITCHFIELD WAY
OSWEGO IL
60543-4203
US

V. Phone/Fax

Practice location:
  • Phone: 630-708-8059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209034793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: