Healthcare Provider Details

I. General information

NPI: 1881331833
Provider Name (Legal Business Name): JORDAN LYNNE WENDEL MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

IV. Provider business mailing address

601 S EDWIN C MOSES BLVD
DAYTON OH
45417-3424
US

V. Phone/Fax

Practice location:
  • Phone: 937-934-4327
  • Fax:
Mailing address:
  • Phone: 937-734-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: