Healthcare Provider Details

I. General information

NPI: 1073017281
Provider Name (Legal Business Name): HEATHER ROSE JORDAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 68TH ST SE
GRAND RAPIDS MI
49548-6927
US

IV. Provider business mailing address

2460 BURTON ST SE
GRAND RAPIDS MI
49546-4801
US

V. Phone/Fax

Practice location:
  • Phone: 616-258-7467
  • Fax: 616-258-7432
Mailing address:
  • Phone: 616-309-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101006787
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: