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General NPI Number Information
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NPI Number | 1023567740
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Entity Type | Individual
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Provider Name | JORDAN LEIGH RHODES LISW, MSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 4822 MARKET ST
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City | BOARDMAN
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State | OH
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Zip | 44512-2148
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Country | US
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Telephone | 330-544-8005
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Fax | 330-544-9379
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Provider Business Mailing Address
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Address Line | 4822 MARKET ST
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City | BOARDMAN
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State | OH
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Zip | 44512-2148
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Country | US
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Telephone | 330-544-8005
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Fax | 330-544-9379
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1600786
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1801107
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License Number State | OH
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