Healthcare Provider Details

I. General information

NPI: 1013033125
Provider Name (Legal Business Name): PATRICIA L. JORDAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 N MERIDIAN ST
INDIANAPOLIS IN
46204-1098
US

IV. Provider business mailing address

6407 MICHIGAN RD
INDIANAPOLIS IN
46268-2731
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-2703
  • Fax: 317-554-2721
Mailing address:
  • Phone: 317-554-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003418A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: