Healthcare Provider Details

I. General information

NPI: 1871357319
Provider Name (Legal Business Name): JORDYN A BLACKFORD CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

IV. Provider business mailing address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

V. Phone/Fax

Practice location:
  • Phone: 740-901-3049
  • Fax:
Mailing address:
  • Phone: 740-796-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.184312
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.004296
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: