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General NPI Number Information
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NPI Number | 1013033125
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Entity Type | Individual
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Provider Name | PATRICIA L. JORDAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 850 N MERIDIAN ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-1098
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Country | US
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Telephone | 317-554-2703
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Fax | 317-554-2721
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Provider Business Mailing Address
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Address Line | 6407 MICHIGAN RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2731
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Country | US
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Telephone | 317-554-2703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34003418A
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License Number State | IN
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