Healthcare Provider Details

I. General information

NPI: 1952237232
Provider Name (Legal Business Name): JACQUELINE M JORDAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 N JACKSON ST
BLOOMINGTON IN
47404-3385
US

IV. Provider business mailing address

1117 N JACKSON ST
BLOOMINGTON IN
47404-3385
US

V. Phone/Fax

Practice location:
  • Phone: 812-361-8568
  • Fax: 812-339-4436
Mailing address:
  • Phone: 812-361-8568
  • Fax: 812-339-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. JACQUELINE MARIE JORDAN
Title or Position: THERAPIST
Credential: LCSW
Phone: 812-361-8568