Healthcare Provider Details

I. General information

NPI: 1598809576
Provider Name (Legal Business Name): STEPHANIE JORDAN OMD, PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7390 W SAHARA AVE SUITE 235
LAS VEGAS NV
89117-2763
US

IV. Provider business mailing address

7390 W SAHARA AVE SUITE 235
LAS VEGAS NV
89117-2763
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-8484
  • Fax: 702-382-3755
Mailing address:
  • Phone: 702-382-8484
  • Fax: 702-382-3755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3356
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1014
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: