Healthcare Provider Details

I. General information

NPI: 1255042818
Provider Name (Legal Business Name): JORDAN BELDING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN CARLSON

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38219 MOUND RD
STERLING HEIGHTS MI
48310-3466
US

IV. Provider business mailing address

38219 MOUND RD STE 101
STERLING HEIGHTS MI
48310-3466
US

V. Phone/Fax

Practice location:
  • Phone: 734-545-6335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401002173
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: