Healthcare Provider Details

I. General information

NPI: 1639615321
Provider Name (Legal Business Name): JORDAN DANIEL STRICKLEN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 KENMOOR AVE SE STE A
GRAND RAPIDS MI
49546-2390
US

IV. Provider business mailing address

509 HARTFIELD DR SE
ADA MI
49301-7707
US

V. Phone/Fax

Practice location:
  • Phone: 616-551-4690
  • Fax:
Mailing address:
  • Phone: 616-401-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6351004119
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301018878
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: