Healthcare Provider Details

I. General information

NPI: 1679400188
Provider Name (Legal Business Name): RYAN JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BROADCASTING RD
WYOMISSING PA
19610-3221
US

IV. Provider business mailing address

1220 BROADCASTING RD
WYOMISSING PA
19610-3221
US

V. Phone/Fax

Practice location:
  • Phone: 610-854-8281
  • Fax:
Mailing address:
  • Phone: 610-854-8281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: