Healthcare Provider Details

I. General information

NPI: 1639000862
Provider Name (Legal Business Name): JORDAN HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 S 48TH ST STE 101
LINCOLN NE
68506-5513
US

IV. Provider business mailing address

185 ROUTE 70 STE 302
TOMS RIVER NJ
08755-0911
US

V. Phone/Fax

Practice location:
  • Phone: 402-218-4667
  • Fax:
Mailing address:
  • Phone:
  • 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: