Healthcare Provider Details

I. General information

NPI: 1700097250
Provider Name (Legal Business Name): TRISHA A JORDAN MA, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA A WRIGHT BS

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 MCPHERSON ST SUITE 2
NORTH BEND OR
97459-3482
US

IV. Provider business mailing address

1975 MCPHERSON ST SUITE 2
NORTH BEND OR
97459-3482
US

V. Phone/Fax

Practice location:
  • Phone: 541-751-2521
  • Fax: 541-751-2661
Mailing address:
  • Phone: 541-751-2521
  • Fax: 541-751-2661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: