Healthcare Provider Details

I. General information

NPI: 1689310047
Provider Name (Legal Business Name): JORDAN ALYSSA WELCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38555 MOUND RD STE 100
STERLING HEIGHTS MI
48310-3206
US

IV. Provider business mailing address

38555 MOUND RD STE 100
STERLING HEIGHTS MI
48310-3206
US

V. Phone/Fax

Practice location:
  • Phone: 586-232-1040
  • Fax: 586-232-1022
Mailing address:
  • Phone: 586-232-1040
  • Fax: 586-232-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: