Healthcare Provider Details

I. General information

NPI: 1932991809
Provider Name (Legal Business Name): LINDA CAROL JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23800 NORTHWESTERN HWY STE 190L
SOUTHFIELD MI
48075-7740
US

IV. Provider business mailing address

1968 JOHN B AVE
WARREN MI
48091-2444
US

V. Phone/Fax

Practice location:
  • Phone: 877-927-8461
  • Fax:
Mailing address:
  • Phone: 586-443-8760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: