Healthcare Provider Details

I. General information

NPI: 1265742993
Provider Name (Legal Business Name): LORRAINE LYNN JORDAN-SHTELEN MSW, LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

IV. Provider business mailing address

7100 GRAPHICS WAY STE 3100
LEWIS CENTER OH
43035-1122
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-7876
  • Fax: 614-457-7896
Mailing address:
  • Phone: 740-428-0428
  • Fax: 740-909-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1700086-SUPV
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1000928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: