Healthcare Provider Details

I. General information

NPI: 1528728151
Provider Name (Legal Business Name): JORDAN TAYLOR HEIDE BA, CC, CPC, SUDPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SUMMIT AVE
EVERETT WA
98201-3309
US

IV. Provider business mailing address

2601 SUMMIT AVE
EVERETT WA
98201-3309
US

V. Phone/Fax

Practice location:
  • Phone: 425-258-2407
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDPT.CO.61111751
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCCC.CL.61096693
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPST.PE.70069105
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: