Healthcare Provider Details

I. General information

NPI: 1568096782
Provider Name (Legal Business Name): BREANA JORDAN HULSEY BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BREANA JORDAN HOPPER BSW, LSW

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST
FAIRBORN OH
45324-5090
US

IV. Provider business mailing address

100 CROWNE POINT PL
CINCINNATI OH
45241-5427
US

V. Phone/Fax

Practice location:
  • Phone: 937-281-4673
  • Fax:
Mailing address:
  • Phone: 513-743-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW.1904297
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1904297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: