Healthcare Provider Details

I. General information

NPI: 1407369358
Provider Name (Legal Business Name): JORDAN GRACE KLING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 NW GREELEY AVE
BEND OR
97703-2943
US

IV. Provider business mailing address

19 SE BENAIAH CIR
BEND OR
97702-1554
US

V. Phone/Fax

Practice location:
  • Phone: 541-316-0061
  • Fax:
Mailing address:
  • Phone: 541-890-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL10964
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: