Healthcare Provider Details

I. General information

NPI: 1093215824
Provider Name (Legal Business Name): JORDAN S. BUCHANAN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ALTON AVE
COLUMBUS OH
43219-3711
US

IV. Provider business mailing address

1801 WATERMARK DR STE 200
COLUMBUS OH
43215-7088
US

V. Phone/Fax

Practice location:
  • Phone: 614-487-8758
  • Fax:
Mailing address:
  • Phone: 614-487-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1700253
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: