Healthcare Provider Details

I. General information

NPI: 1801409800
Provider Name (Legal Business Name): MS. JORDAN MARIE KESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN MARIE HENDRY

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19251 MACK AVE UNIT M450
GROSSE POINTE WOODS MI
48236-2893
US

IV. Provider business mailing address

32100 TELEGRAPH RD STE 205
BINGHAM FARMS MI
48025-2454
US

V. Phone/Fax

Practice location:
  • Phone: 248-252-7935
  • Fax:
Mailing address:
  • Phone: 248-712-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: